From May 2004 to March 2009, we admitted 24 patients with aneurysms of the superior segment of the bed of the internal carotid artery, accounting for 16.8% of all aneurysms (24/143). Most of them are complex large and giant aneurysms, which are difficult to treat. The surgical methods include clamping, isolation + intracranial and extracranial artery bypass, and partial resection of the aneurysm-carrying artery reconstruction. In order to summarize the experience and lessons learned in microneurosurgery of aneurysms in this area to further improve the outcome, we report the following summary with the literature.