A 64-year-old man, who had undergone clipping surgery 18 years before for a ruptured anterior communicating artery (ACoA) aneurysm, presented with mild aphasia. A computerized tomography (CT) scan showed a subcortical hemorrhage in the left temporal lobe, and a high density large mass at the ACoA. Neuro-imaging study revealed a giant thrombosed ACoA aneurysm. Thrombectomy and neck clipping were successfully performed, using the interhemispheric approach. The patient was discharged without additional neurological deficits. A long-term follow-up study is thus considered necessary after neck clipping of a ruptured aneurysm.