【Abstract】 Objective To evaluate the clinical strategy and effect of subfrontal keyhole approach in surgical treatment for intracranial anterior circulation aneurysms. Methods The skin incision, located at superciliary arch along with the dermatoglyph, is about 6cm length(the medial border close to median line and the lateral reach to frontal process over 1cm ). Boring a hole at the temporal line and shaping a 2.0cm×4.0cm bone window including orbital border with milling cut. Curved open the dura, uplift the frontal lobe and reveal the ipsilateral optic nerve with help of operating microscope. Unrip arachnoid mater locating at the two sides of optic nerve and release cerebrospinal fluid slowly, then dissect the root of lateral fissure according to the position of the aneurysms after brain collapsed well. It is essential to dissect the root of lateral fissure about 1～2cm length for internal carotid posterior communicating artery aneurysms and middle cerebral artery aneurysms, or reveal the anterior communicating artery aneurysms along with the anterior cerebral artery. 78 cases diagnosed anterior circulation aneurysms were operated with subfrontal keyhole approach using microscope (including 7 cases with help of the endoscope), 82 aneurysms were treated with surgical clipping and 3 aneurysms wrapped up. Results The clinical mortality rate is 1.2%（1/78 cases） and 69 cases survived well following up from 1～24 months. Conclusions The subfrontal keyhole approach is suitable for treating intracranial anterior circulation aneurysms, which has the merit of minimally invasive, save the operation time, small operation skin incision and maintain good appearance.