To exlore the approach for treating carotid-ophthalmic aneurysms and introduce experience in reducing postoperative complications. We treated 31 patients with carotid-ophthalmic aneurysms, which accounted for 8.3% of all intracranial aneurysms we encountered in 1994 and 1997, by direct surgical clipping. No operative death occurred and the rate of postoperative complications was 19%. All aneurysms were occluded and later confirmed by angiography. The direct clipping of aneurysms involving the carotid-ophthalmic artery is best treated by the extradural-intradural approach.