The distal middle cerebral artery spindle and serpentine aneurysms are difficult to treat and cannot be directly clamped but can only be isolated or resected, and are prone to cerebral infarction after surgery leading to limb paralysis, sensory impairment and other serious neurological dysfunction. In the dominant hemisphere may also lead to language disorders aphasia assisted by various vascular bypass surgeries, treatment of such aneurysms can effectively prevent the occurrence of cerebral infarction. in May 2008 December 2009, Beijing Sanbo Brain Hospital used intracranial vascular bypass plus aneurysm isolation or resection surgery to treat distal middle cerebral artery shuttle and serpentine aneurysms, the following is reported and the surgical techniques and strategies are analyzed.