As increasing of the population of th old age (over 65), the numbers of aneurysm, surgery in the elderly also were increased. But, the decision to treat intracranial aneurysm still remains difficult problem whether it is ruptured or unruptured and many neurosurgeons hesitate to operate these elderly patients becase of less favorable outcome. In this study, the author reviewed several articles which written and discussed about aneuryamal surgery of the elderly patients. The main focuses of review are risk factors, treatment option and outcomes, surgical decision, operative indications and contraindications, and prognostic factors. The conclusion of this review is that eventhough advanced age reveals less favorable outcome, it is not due to pure old age alone but due to associated medical condition. The outcome in young and old patients in same clinical condition was similar. So, with holding treatment of cerebral aneurysm on adbanced age is not always be justfied. Physiologic rather than chronologic age together with patient's lives on pre-attack and clinical status on attack should be considered as the basis of treatment recommendation in the elderly patient with cerebral aneurysm. After surgery, aggressive treatment and prevention of medical complications can lead ot a better outcome.