Cerebral aneurysms are treated by two methods: direct microsurgical clipping and 
endovascular coiling. Both are selected based on definite guidelines for 
clinicoradiological criteria as follows: Endovascular therapy comprising of GDC 
embolization, CSF wash-out with UK or TP A were performed in cases with Hunt and 
Kosnik grade 4 (GCS 7, 8), and grade 5 (without hydrocephalus or intracranial 
hemorrhage), age>70 years, subacute stage (4--14 days of vasospasm), basilar 
aneurysm and peripheral MCA/PCA aneurysms. Microsurgical clipping with a 
drainage procedure was performed in cases with Hunt and Kosnik grades 0--3, 
grade 4 (GCS 9--12), age less than 70 years, grade 5 with hydrocephalus or 
intracerebral hematoma and acute stage (0--3 days after bleed). The patient's 
outcome was measured using GOS (Glasgow outcome score) at the time of discharge. 
In our series of severe (poor grade) SAH cases, 120 cases underwent clipping and 
59 cases underwent coiling. Although they accounted for 37.8 % and 48 % of total 
SAH cases, respectively, the outcome was satisfactory. Good recovery and 
moderate disability, together termed "favorable outcome" was found in 69.16 % of 
clipping cases and 44.06 % of coiling cases. Clipping had a better outcome than 
coiling in cases of acute severe SAH in our series. The golden hour 
resuscitation, pre-hospital care and the adjunctive treatment strategies like 
hypothermia are discussed. A critical appraisal of the ISAT of microsurgical 
clipping versus coiling is used for comparison of our results.