This chapter provides detail description of Anterior communicating artery aneurysms. Chapter has 8 well illustrated diagrams and pictures. Anterior communicating artery (ACoA) aneurysms, surgical milestones in the management of anterior communicating artery aneurysms, microsurgical anatomy of anterior communicating artery complex, anterior communicating artery complex, anterior communicating artery syndrome, investigations of anterior communicating artery, clipping and coiling debate in the management of anterior communicating artery aneurysms, approaches to anterior communicating artery aneurysms, the sub frontal modified gyrus rectus approach, Pterional craniotomy, giant anterior communicating artery aneurysms, fusiform anterior communicating artery aneurysms, blister like anterior communicating artery aneurysms, kissing anterior communicating artery aneurysms, complications of anterior communicating artery aneurysms and neuropsychological sequelae are described in detail. 119 references are included at the end of the chapter to facilitate further reading.