Abstract： Objective To explore the efficacy of surgery on ruptured anterior communicating artery aneurysm via interhemispheric approach Methods An analysis and summary of the clinical data were performed in 23 patients with anterior communicating artery aneurysm, admitted to our hospital from January 2008 to August 2009. The clinical manifestations and surgical outcomes were analyzed to evaluate the significance of interhemispheric approach. Results Three aneurysms ruptured during the operation, and 8 aneurysms were excised after being clipped. All patients received CT scan 1 d after the operation and on the day the patients discharged to confirm that no hydrocephalus and brain tissue infarction appeared. All the patients were performed transcranial Doppler ultrasonography on the 3rd d of operation, indicating that 5 patients emerged cerebral angiospasm, and 2 of these 5 patients appeared frontal psychiatric symptoms and recovered 1 week later. No disability or death was noticed.Conclusion Interhemispheric approach enjoys its superiority in treating anterior communicating artery aneurysm: it can help to expose the anterior communicating artery complex and neck of the aneurysm,therefore, anterior communicating artery aneurysm can be clipped, and the interhemispheric hematoma can be cleaned up and the happening of post-operative vasospasm can be decreased.