Most intracranial aneurysm can be managed with either microsurgical clipping or endovascular coiling. aneurysms that arose from ophthalmic segment, ICa, are always challenging because of difficult anatomical position, which impose, besides performing of basic approach (pterional, oZY), to perform an extradural clinoidectomy, to get the right view to aneurysm’s neck. We present a case-report of an ophthalmic giant ruptured aneurysm of the left internal carotid artery (ICa) in a 63 years old female. She was admitted to our department three days after rupture. Computed tomography angiography revealed a giant ophthalmic aneurysm on the left. Neurologically she presented in Hunt-Hess 2. after the resolution of vasospasm we perform a left side pterional approach with extra-intradural clinoidectomy. This was enough to get the right angle and to place the clip. We placed one Yasargil clip that was enough to exclude the aneurysm from circulation. after operation the patient spent six days in the ICU. later she improved and was discharged without any neurological deficit. anterior clinoidectomy in some cases is an essential technique that allows us to successfully clip aneurysms which in the past were unclippable. That’s why it is important, that in the period when endovascular techniques provide a real challenge for open surgery, every neurosurgeon should be able to perform complex procedure in case it is needed.