Anterior cerebral artery is one of the most common site forintracranial aneurysms, it represents about 30-39% of all intracranialaneurysms. A. com artery is commonest site for A.C.A. aneurysm,represent about 35% of all intracerebral aneurysms.Twenty cases of anterior cerebral artery aneurysms were included inthis study. Seven cases were admitted in the Neurosurgical Department ofKasr El-Aini University Hospital, seven cases in French EducationalHospital and six cases in El-Salam International Hospital. Eighteen caseswere treated by microsurgical clipping and 2 cases by endovascular coiling.Early securing of the aneurysms and nimodipine treatment reduce theincidence of rebleeding as well as delayed ischemic neurological deficits.In addition early aneurysms treatment could safely permit inducedhypertension and hypervolemia which could reverse incipient delayedischemic neurologic deficit.The most commonly used surgical approach for these aneurysm ispterional trans-sylvian approach, craniotomy is usually performed from theright side, exception to this include: left intracerebral hematoma, leftdominant A1, additional left side aneurysms and unexperienced left handedsurgeon.