Intracranial aneurysm rupture leads to aneurysmal subarachnoid hemorrhage (aSAH), which is a devastating condition with high morbidity and mortality. Aim and objectives: The purpose of this study was to perform a comprehensive analysis of complications and outcomes in patients with ruptured anterior cerebral circulation aneurysms after early surgery. Subjects and methods: This is a Cohort study which was conducted on 25 patients with anterior cerebral aneurysmal subarachnoid hemorrhage (aSAH) whom operated upon by microsurgical clipping within 10 days of SAH ictus at Neurosurgery Department, Faculty of Medicine Cairo University Hospitals, Egypt. Results: there was a statistically significant difference between the studied groups regarding to worsening after 24 hs as same or improved male count is 10 with 90.0% while female count is 6 with 42.9% and worsen male count is 1 with 9.1% while female count is 8 with 57.1%. there was a statistically significant difference between the studied groups regarding to GCS on admission (same or improved mean is 14.19 and Standard Deviation is 1.68) and (worsen mean is 12.22 and Standard Deviation is 2.11) with P value equal 0.017. Conclusion: The higher the grade of Hunt and Hess, Fisher and WFNS SAH the worse the outcomes of surgery. Early clipping was found to prefer as regard to patient outcome