Objective To analyze and compare the efficacy and safety of surgical treatment of intracranial anterior circulation aneurysms in elderly patients of different ages. Methods 95 elderly patients with intracranial anterior circulation aneurysms who underwent surgical treatment in the Department of Neurosurgery, Zhongnan Hospital of Wuhan University from March 2018 to December 2020 were retrospectively analyzed, and these patients were divided into two groups according to their age: younger elderly (60-69 years old) and elderly (≥70 years old). Basic information, medical history and clinical data were collected for these patients, including Glasgow Coma Scale (GCS), modified Fisher (mFisher) score, Glasgow outcome score (GOS) and modified Rankin score (mRS). Results A total of 95 elderly patients were included, and the mean age of all patients was 67.9 ± 4.3 years. There were no significant differences in sex, comorbidities, GCS, mFisher score, aneurysm location, presence or absence of aneurysm rupture, aneurysm morphology, and the number of aneurysms, and aneurysm size in patients between two groups (P > 0.05). The incidence of postoperative procedure-related complications in the two groups was 12% and 35%, respectively (P = 0.015), and complete occlusion on imaging was achieved in all patients by surgery. Both groups had similar GOS (P > 0.999) and in-hospital mortality (P = 0.512), and there was no significant difference in mRS during follow-up (P = 0.677). Hospitalization costs were significantly lower in the younger elderly group compared to the older group (P = 0.003). No recurrence of aneurysm was observed on imaging during follow-up between two groups. Conclusions Surgical risk of microsurgical clipping of anterior circulation aneurysms increases with age in old patients. Considering the relatively low incidence of procedure-related complications in younger elderly patients, microsurgical clipping is a relatively feasible and safe procedure in the treatment of younger elderly patients with anterior circulation aneurysms compared with elderly patients.