目的　总结颅内动脉瘤显微外科手术的治疗经验。方法　统计近年 2年来显微外科手术夹闭的 16 3例颅内动脉瘤患者的临床资料、手术方式及术后转归。结果　成功夹闭 16 2例 ,5例为栓塞失败后改为手术夹闭。术中过早破裂 31例 ,其中 1例在切开脑膜前破裂 ,未予夹闭。 112例恢复正常工作 (6 9 6 % ) ,轻残 19例 ,重度残废 2 1例 ,死亡 8例 (4 9% ) ,术后脑积水 32例。结论　颅内动脉瘤一旦诊断明确 ,即应积极处理 ,Hunt和Hess 4～ 5级者入院后延迟手术可能减少手术死亡率 ,但在等待期间可能增加再破裂出血的危险 ,因而总死亡率不减少。颅底外科入路及精细的显微操作可减少术中过早破裂。前循环和后循环动脉瘤的术中处理有不同 ,脑积水为最常见的远期并发症 ,需行脑室腰腔分流术 Objective To summarize the experience of microsurgery for intracranial aneurysms. Methods The clinical data, surgical procedures and postoperative outcomes of 16 3 patients with intracranial aneurysm occluded by microsurgery in recent 2 years were collected. Results Successful clipping 16 2 cases, 5 cases of embolization failed to change to surgical clipping. 31 cases of premature rupture, including 1 case of rupture in the incision before the meningeal, not clipping. 112 cases returned to normal operation (69.6%), 19 cases were mild disability, 21 cases were severe disability, 8 cases died (49%), and 32 cases had postoperative hydrocephalus. Conclusions Once the diagnosis of intracranial aneurysms, should be actively treated, Hunt and Hess 4 to 5 patients after admission delayed surgery may reduce the operative mortality, but may increase the risk of rebleeding and bleeding, so the total mortality did not decrease . Skull base surgery and fine micromanipulation can reduce preoperative rupture. Preoperative and postoperative circulatory aneurysms have different treatment, hydrocephalus is the most common long-term complications, need to be ventricular lumbar shunt