Abstract: Objective To investigate the surgical strategies of paraclinoid aneurysms and analyze its clinical outcomes. Methods Clinical data about 46 patients with paraclinoid aneurysm who were surgically treated in our hospital from January 2010 to May 2014 were retrospectively analyzed. Of the 46 patients with total 49 aneurysms, 8 were males, 38 were females with the mean age of 50.15 years (range:22-72). 17 patients had ruptured aneurysm and 9 patients had multiple aneurysms. There were 22 ophthalmic aneurysms, 10 globe aneurysms, 8 superior hypophyseal aneurysms, 3 carotid cave aneurysms, 1 serpentine aneurysm and 5 pseudoaneurysms. The diameters of 20 aneurysms were smaller than 5 mm, 15 were between 5 mm and 15 mm, and 14 aneurysms were larger than 15 mm. Surgical strategies included simple clipping, clip reconstruction, extracranial-to-intracranial (EC-IC) bypass, cervical ICA ligation and aneurysm wrapping. Clinical outcome was evaluated by Glasgow outcome scale (GOS). Results 19 aneurysms were clipped, 21 aneurysms were treated by clip reconstruction, 6 aneurysms were treated by EC-IC bypass, 2 aneurysms were treated by cervical ICA ligation, and 1 aneurysm was treated by wrapping. According to the GOS, 42 patients had good outcomes (GOS 4, 5), 3 had poor outcomes (GOS 2, 3) and 1 was dead (GOS 1). Conclusion According to the individual characteristics of paraclinoid aneurysm, appropriate surgical strategies for patients are applied, which can improve the clinical outcomes.