Objectives: To compare two groups of participants treated by one of two surgical procedures of anterior cerebral circulation aneurysm treatment, pterional approach or supraorbital keyhole approach, according to considered parameters and, based on that comparison, bring conclusions on whether any of the parameters are related to other and on possible advantages and disadvantages of one approach compared to the other. Study design: Retrospective cohort study. Participants and methods: The study included 116 participants that had an anterior circulation cerebral aneurysm identified by radiological examination and were submitted to one of the two mentioned surgical approaches between 2006 and 2015 at the Clinic of Neurosurgery at Clinical Hospital Center Osijek. All data regarding the considered parameters (age, gender, GCS score, WFNS score, Hunt and Hess score, Fisher score, aneurysm localization, concomitant diseases, presence of rupture and elapsed time between the rupture and hospital reception, surgery timing, procedural or postoperative care complications, GOS score) were obtained from participants' medical records and statistically analyzed. Results: Significant difference between the defined groups was found in aneurysm localization distribution regarding the participants with anterior communicating artery (ACOM) aneurysm (χ2 test, p = 0,039). Furthermore, significant difference in the distribution of GOS score and Hunt and Hess score was found when the participants who were divided into two groups, according to the range which their Hunt and Hess score could fit into (χ2 test, p = 0,021). Statistically significant difference between the defined groups in the distribution of any other considered parameter was not found. Conclusion: Pterional approach and supraorbital keyhole approach are equally successful in treating anterior circulation cerebral aneurysms and the decision on which approach should be applied, should be made based on the individual assessment and surgeon's preferences. The final outcome of the treatment does not depend on the applied surgical approach but it depends on patient's Hunt and Hess score at the reception.