Objective To compare the efficacy of different surgical strategies in the treatment of multiple intracranial aneurysms, and provide reference for the treatment of multiple intracranial aneurysms in clinical practice. Methods The clinical data of 70 patients with multiple intracranial aneurysms treated in three neurosurgical wards of Shengjing Hospital Affiliated to China Medical University from August 2011 to December 2020 were retrospectively analyzed. All cases were grouped according to craniotomy or interventional embolization, unilateral or bilateral surgery, primary or staging surgery, management of responsible aneurysms, or management of all aneurysms. The therapeutic effects of different surgical strategies were analyzed by comparing the postoperative GOS score, postoperative rebleeding, postoperative complications and other prognostic indicators. Results In univariate analysis, the clinical efficacy of endovascular coiling was better than that of intracranial clipping, and the clinical efficacy of dealing all aneurysms was better than that of only dealing with responsible aneurysms. The influence of surgical side and surgical stage on prognosis was not statistically significant. The postoperative rebleeding and postoperative complications were not statistically significant; In multivariate analysis, preoperative Hunt-Hess scores and the choice of surgical method were the independent risk factors affecting the prognosis the disease. Conclusion For the treatment of multiple aneurysms, endovascular coiling should be chossen priority. In the treatment of multiple aneurysms with definite diagnosis, all aneurysms should be treated as far as possible. The treatment of unruptured aneurysms should follow certain principles.