Summary:The anatomical and surgical aspects of treatment of the major anterior circulation aneurysm types are discussed. The morbidity and mortality from major historical series are provided. The management of associated intraventricular and intracerebral hematomas is considered as is data bearing on the timing of surgery controversy. The results of a personally operated series of 100 aneurysms are analyzed with respect to prognostic factors, operative considerations and outcome. Early surgery and new strategies to prevent vasospasm appear to be the best hope for the patient with a recently ruptured aneurysm.