en Functional Neurosurgery Research <strong>Background and Aim:</strong> Subarachnoid hemorrhage (SAH) resulting from ruptured intracranial aneurysms is associated with high mortality rates and presents a significant clinical challenge. The primary interventions to mitigate the risk of rebleeding and improve patient outcomes are neurosurgical clipping and endovascular coiling. While neurosurgical clipping has historically been the gold standard, endovascular coiling offers a less invasive alternative. Accordingly, this study compares the efficacy and outcomes of these two interventions in patients with aneurysmal SAH.<br> <strong>Methods and Materials/Patients:</strong> A total of 65 consecutive patients with aneurysmal SAH, treated either with neurosurgical clipping or endovascular coiling, were included in the retrospective cohort study. Functional outcomes were assessed using the modified Rankin score, and the complications were evaluated.<br> <strong>Results:</strong> No significant differences were found in functional outcomes between neurosurgical clipping and endovascular coiling groups (P=0.92); however, patients undergoing endovascular coiling had shorter lengths of in-hospital and in-intensive care unit stays compared to those treated with neurosurgical clipping (P=0.02). Conversely, endovascular coiling was associated with higher intervention costs (P<0.01). Subgroup analyses based on disease severity revealed small differences in functional outcomes between the two groups.<br> <strong>Conclusion:</strong> While both neurosurgical clipping and endovascular coiling demonstrate comparable efficacy in preventing rebleeding and improving functional outcomes, they present distinct advantages and considerations. Future studies should be performed to improve treatment algorithms and patient outcomes in this complex clinical situation. Additionally, larger prospective studies are needed to validate these findings and provide stronger evidence for guiding clinical decision-making. Subarachnoid hemorrhage, Aneurysm, Endovascular coiling, Neurosurgical clipping 0 0 http://irjns.org/browse.php?a_code=A-10-726-1&slc_lang=en&sid=1 Ali Batiar dralibatiar@gmail.com 100319475328460012544 100319475328460012544 No Golestan University of medical sciences Mohammad Hossein Mirbolouk Mirbolouk@gmail.com 100319475328460012545 100319475328460012545 No Iran University of Medical Science Mohsen Nabiuni nabiuni.m@iums.ac.ir 100319475328460012546 100319475328460012546 No Iran University of Medical Science Aidin Fateme dr.sajedy@gmail.com 100319475328460012547 100319475328460012547 No Golestan University of medical sciences Fateme Shahrokhi fateme.shahrokhi1996@gmail.com 100319475328460012548 100319475328460012548 No Golestan University of medical sciences Rahim Kohansal kohansal.ra@gmail.com 100319475328460012549 100319475328460012549 No Golestan University of medical sciences Rouzbeh Shams Amiri rshamsa@gmail.com 100319475328460012550 100319475328460012550 Yes Golestan University of medical sciences