Abstract: Objective:To investigate the clinical effects of microsurgery in treating the rupturing anterior communicating artery aneurysm.Methods:The clinical data of 23 cases with rupturing anterior communicating artery aneurysm were retrospectively analyzed.Sixteen cases were treated with Yasargil pterional approach,7 cases were treated with supraorbital keyhole approach.Results:According to the Glasgow Outcome Score,18 patients(78.3%) were complete recovery,1 case(4.3%) was moderate disability,2 cases(8.7%) were severe disability and 2 cases(8.7%) died.All patients were followed up for 6 to 12 months.No incomplete or false clipping vessel were observed by the postoperative CTA.Conclusions:The pterional approach and supraorbital keyhole approach,which can fully expose the aneurysms,is an effective method in treating anterior communicating artery aneurysms in the patients with grade Ⅰto Ⅲ of Hunt-Hess rupture.