Introduction: Aneurysmal subarachnoid hemorrhage is a life-threatening condition associated with poor clinical and neurological outcomes. Advances in surgical and endovascular interventions have improved mortality rates in patients with ruptured intracranial aneurysm. Objective: To evaluate the impact of early microsurgical management on clinical outcome of patients with ruptured intracranial aneurysm. Method: Retrospective observational study with patients admitted at the Emergency Department of a public tertiary center with aneurysmal subarachnoid hemorrhage, from October 2015 to June 2020. Results: Two hundred twenty-eight patients were treated with microsurgical techniques, totalizing 289 clipped aneurysms. One hundred sixty-nine (74.12%) patients were women and 59 (25.88%) men. At admission, 166 (72.81%) patients were classified according the Hunt-Hess Scale as I to III and 62 (27.19%) were IV and V. One hundred twenty-six (55.26%) were treated <48h following subarachnoid hemorrhage and 102 (44.74%) >48h. After six months of follow-up, 89 (70.63%) early treated patients (<48h) were mRS≤3, 16 (12.70%) were mRS 4 or 5 and 21 (16.67%) died, with an average hospital stay of 28 days; while 49 (48.04%) late treated patients (>48h) were mRS≤3, 19 (18.63%) were mRS 4 or 5 and 34 (33.33%) died, with an average hospital stay of 49 days. Conclusion: Aneurysmal subarachnoid hemorrhage is a serious disease and early microsurgical management represents a key point to successfully treat this life threatening condition.