Eighteen patients with bifurcation of internal carotid artery aneurysms were treated with direct surgery. In all cases the pterional approach was used. The strategy used in dissecting the aneurysm depends on the size of the aneurysm and the length of the intracranial internal carotid artery. When the aneurysm is small, the bifurcation of the internal carotid artery can be exposed by dissecting along the internal carotid artery from a proximal-to-distal direction. The aneurysm and the perforating vessels adjacent to it are identified before the aneurysm is clipped. When the aneurysm is not small or if the intracranial segment of the internal carotid artery is long, the sylvian fissure has to be dissected open before dissection of the aneurysm and perforators is undertaken. Using this dissection strategy, 18 bifurcations of internal carotid artery aneurysms were clipped with 16 excellent, one good, and one fair result. There was no mortality.