Objective To explore the clinical features and microsurgical treatment strategies of the distal anterior cerebral artery aneurysms (DACAA). Methods A retrospective cohort study was conducted on 24 patients with DACAA admitted to Department of Neurosurgery, West China Hospital, Sichuan University from March 2013 to June 2014. All cases received clipping surgery. The aneurysm occlusion was assessed by CTA or DSA post operation and the treatment outcome was evaluated using Glasgow outcome scale (GOS) at discharge and modified Rankin scale (mRS) at follow-up. Results A total of 33 aneurysms of 24 patients were completely clipped during operation. On the day of operation, postoperative CT revealed complete or partial removal of intracranial hematoma. Complete clipping of aneurysm and patency of parent artery or branch artery were confirmed by CTA or 3D-DSA before discharge. Postoperative complications included hematoma expansion in 1 (4.2%) and transient mental disorder in 1 (4.2%). The GOS assessment at discharge revealed grade V in 20 cases, grade IV in 3 and grade III in 1. The follow-up lasted for 6-12 months. The last follow-up revealed the mRS of 0-1 in 21 cases, 2 in 2 and 6 in 1. There were 95.8% (23/24) of 24 patients who achieved good outcome. Conclusion DACAA has a low incidence rate and high surgical risks. Microsurgical clipping could be effective for its treatment. Key words: Intracranial aneurysm; Anterior cerebral artery; Microsurgery; Treatment outcome