"Distal anterior cerebral aneurysm" (DACA) represents 4% of intracranial aneurysms. Two treatment modalities are available, microsurgery and endovascular therapy (EVT). To compare the results between microsurgery and EVT in a modern French cohort. This is a multicenter retrospective cohort study with three French neurosurgical units from January 1, 2015, to December 31, 2020. All participants were adult patients who required treatment of a ruptured or unruptured DACA aneurysm. A total of 69 patients were included, 16 (23.2%) patients were treated by microsurgery, and 53 (76.8%) were treated by EVT. 31 (44.9%) were ruptured aneurysms. The complication rate is low with one death and one symptomatic ischemia. There is no difference for complications between microsurgery and EVT (p=0.22). The number of retreatments is higher in EVT (15% vs 0%) but not significantly (p=0.18). In the specific subgroup of DACA aneurysm, both treatment modalities are effective in ruptured and unruptured aneurysms with a low rate of complications. Retreatment may be more frequent in EVT but it does not lead to more complication.