Objective To analyze the effectiveness and safety of microsurgery for intracranial anterior circulation aneurysms in elderly patients of different ages.Methods We reviewed 95 elderly patients undergoing microsurgery for intracranial anterior circulation aneurysms in the Department of Neurosurgery， Zhongnan Hospital of Wuhan University from March 2018 to December 2020. These patients were divided into younger group （60-69 years old） and older group （≥70 years old）. We collected their data on basic information， medical history， and clinical data including Glasgow Coma Scale （GCS） score， modified Fisher scale （mFisher） score， Glasgow Outcome Scale （GOS） score， and modified Rankin Scale （mRS） score.Results The mean age of the 95 patients was 67.9±4.3 years. There were no significant differences in sex， comorbidities， GCS score， mFisher score， aneurysm location， the presence or absence of aneurysm rupture， and the morphology， number， and size of aneurysms between the two groups （P >0.05）. Both groups underwent microsurgical clipping. The incidence rates of postoperative procedure-related complications in the two groups were 12% and 35%， respectively （P = 0.015）. Complete occlusion was achieved on imaging for all the aneurysm procedures. The two groups showed no significant differences in GOS score （P >0.999）， in-hospital mortality （P = 0.512）， and mRS score at follow-up （P = 0.677）. Hospital cost was significantly lower in the younger group than in the older group （P = 0.003）. No recurrence of aneurysm was observed by imaging during follow-up between the two groups.Conclusions The risk of microsurgical clipping for anterior circulation aneurysms increases with age in elderly patients. Microsurgical clipping is a relatively feasible and safe procedure in the treatment of younger elderly patients with anterior circulation aneurysms.