Patients with bilateral anterior circulation aneurysms present a management challenge. These lesions may be treated in a staged manner or alternatively, for select patients, a contralateral approach may be utilized to treat bilateral aneurysms with a single surgery. In this narrated video illustration, the authors present the case of a 57-year-old woman with incidentally discovered bilateral aneurysms (left middle cerebral artery (MCA), left anterior choroidal artery and right MCA). A contralateral approach through a left pterional craniotomy was performed for microsurgical clipping of all three aneurysms. The techniques of pterional craniotomy, contralateral approach, microsurgical clipping, and intraoperative angiography are reviewed.