Objective: To explore the clinical benefits of vascular embolization and intracranial clipping in the surgical treatment of grade IV–V aneurysmal subarachnoid hemorrhage (aSAH) of the World Federation of Neurosurgery (WFNS). Methods: The data of 134 patients with WFNS grade IV–V aSAH hospitalized in the Department of Neurosurgery of Qionghai People’s Hospital from April 2019 to September 2021 were analyzed retrospectively. According to different treatment methods, they were divided into an embolization group (n=64) and an intracranial clipping group (n=70). The operation and 3-month follow-up of the 2 groups were classified and compared. Results: The operation time and hospital stay in the embolization group were shorter than those in the intracranial clipping group (both P<0.05). The incidence of cerebral vasospasm (CVS) was 4.69%, and the total incidence of complications was 10.94%, which was lower than 15.71% and 25.71% in the intracranial clipping group (both P<0.05). Three months after the operation, the good prognosis rate in the embolization group was 70.31%, which was higher than 52.86% in the intracranial clipping group (P<0.05), and the incidence of cognitive impairment was 45.31%, which was lower than 62.86% in the intracranial clipping group (P<0.05). Conclusion: Compared with intracranial clipping in the treatment of WFNS grade IV–V aSAH, vascular embolization not only has the advantages of saving operation time, shortening hospital stay, and reducing CVS and other complications, but also may have obvious advantages in improving the short-term prognosis and reducing cognitive damage, so as to improve the clinical benefit.