OBJECTIVE: Anterior circulation aneurysms with complex anatomical location and aneurysm structure, multiple clinical occurrences and difficulty in determining the rupture responsibility of the aneurysm pose a challenge to surgical closure and surgical strategy, what kind of closure and method and multiple aneurysm management strategy can directly affect the prognosis of the patients, how to perform effective closure of these aneurysms or to choose the optimal therapeutic strategy is still a clinical problem that needs to be explored. METHODS: We classified complex ruptured anterior circulation aneurysms according to their location as follows: Complex posterior communicating aneurysms: anatomical location: neck of the aneurysm partially concealed by the anterior bed process; posterior cerebral artery visualized only when the internal carotid artery is lateral to the aneurysm; aneurysm structure: large aneurysm with a wide neck (carotid/corporeal) of 1/1; microaneurysm, with the supratentorial artery being in excessively close proximity to the free margin of the canopy; Complex anterior communicating aneurysms: Posterior superior pointing, abnormally weak neck; perforating branch emanating from the aneurysm body; neck covering the entire anterior communicating; contralateral A1 completely rudimentary; complex cavernous sinus segment aneurysm, large, thrombosed; complex ophthalmic artery aneurysm, aneurysm concealed under the anterior bedspread; aneurysm embedded in the distal loop; ruptured intracranial multiple anterior circulatory aneurysms, where determining the responsible ruptured aneurysm is difficult, are also classified as complex anterior circulatory aneurysms. Treatment, complex posterior communication aneurysm: the neck of the aneurysm is covered by the bed protrusion part of the removal of the anterior bed protrusion, to fully expose the proximal and distal ends of the neck of the aneurysm, for the obvious blood flow advantage of the posterior communication artery aneurysm, before and after the clamping of the side of the posterior communication of the blood flow will not be affected; wide neck aneurysm needs to be used in combination with a clamping technique to carry on the effective clamping, the management of the micro-aneurysm mostly needs to be clamped under the situation of temporary obstruction. If the internal carotid artery of the supratentorial segment is too close to the free edge of the canopy, the gap between the internal carotid artery and the optic nerve should be fully utilized for clamping. Complex anterior communicating artery aneurysms that point posteriorly and superiorly are mostly clamped with heterotopic clips, and aneurysms with abnormally weak necks are isolated with confirmation of a well-developed contralateral A1. If the aneurysm has a perforating branch, the neck of the aneurysm should be remodeled to avoid the perforating branch as much as possible, and if the neck of the aneurysm covers the entire anterior communication, it needs to be clipped by transvascular clips, and the intraoperative endoscopic technique is helpful in judging the clipping situation. Complex middle artery aneurysms require a combination of clamping techniques to ensure that middle artery blood flow is not affected. For large cavernous sinus segment aneurysms, bypass + aneurysm isolation is often required. For complex ophthalmic aneurysms with exposure of the internal carotid artery in the neck, the anterior bedside flap sclerotherapy technique reduces the chance of hemorrhage during anterior bedside ablation. For intracranial multiple anterior circulation aneurysms to determine the responsible aneurysm refer to the following criteria: subarachnoid hemorrhage site, vasospasm side, aneurysm shape, aneurysm size, for non-syndromic multiple aneurysms in addition to the responsible aneurysm for hemorrhage, we need to consider the possibility of one-stage surgical clipping, which is determined by the site of the aneurysm, the pointing and the size of the aneurysm, and the need to carry out preoperative CTA or DSA three-dimensional reconstruction. As for multiple aneurysms on the same side, the order of clipping should be the focus of consideration. Results: 13 cases of complex posterior communicating artery aneurysms, 12 cases obtained surgical clamping, 1 case had residual aneurysm neck after clamping; 10 cases of complex anterior communicating artery aneurysms, 8 cases obtained clamping, 2 cases underwent isolation of the anterior communicating artery, of which one case produced ischemic symptoms; 2 cases of cavernous sinus area aneurysms, 1 case was isolated, 1 case was bypassed, and the isolated one produced ischemic symptoms; 4 cases of ophthalmic aneurysms were all obtained clamping, 16 cases of multiple aneurysms, 6 cases were bilateral, 3 cases obtained single aneurysms. case bilateral, 3 cases obtained single-entry clamping, 1 case of one-stage bilateral craniotomy clamping, 2 cases combined with intervention; 10 cases of ipsilateral aneurysms were all clamped in one stage. Conclusion: For complex ruptured anterior circulation aneurysms, effective surgical clamping (isolation of the aneurysm from the circulation and preservation of normal blood vessels) by choosing appropriate clamps and clamping methods can achieve satisfactory clinical outcomes, while multiple aneurysms that cannot be fully clamped by a single approach can be performed by combined interventional therapy.