Background: Management of small aneurysms regularly poses a therapeutic problem and surgical treatment or coiling can be considered as therapeutic choices. In the current study, we reviewed our series of ruptured small cerebral aneurysm preserved surgically. Materials and Methods:A total of 53 consecutive patients with ruptured small aneurysm were surgically treated between November 2014 and November 2016. Data were retrospectively collected. Procedure-related death and complications were systematically reviewed. Clinical outcomes were evaluated utilizing the Modified Ranking Scale. Neuroradiological follow-up was performed to evaluate aneurysmal occlusion and recanalization rate. Results: The mean aneurysm size was 2 mm ± 0.7 mm. All the patients were operated and the aneurysm clipped. Clinical outcomes were as expected on the basis of the presenting Hunt and Hess grade. Generally, major and minor neurological deficit related to clipping were 5% and 3%, respectively. At the time of discharge, 85% of the patients presented with a favorable outcome, while 15% had poor clinical outcome. Aneurysm occlusion was achieved in all the cases. Neither recanalization nor re-aneurysmal rupture was observed in the clinical follow-up. Conclusion: Aneurysms, 3 mm in diameter or smaller, represent a therapeutic challenge. Given the proven role of microsurgery in small aneurysms and the perceived challenges with endovascular therapy, surgical clipping still can be considered an effective treatment modality in this setting.