Abstract: Objective To explore the effect of perioperative nursing for elderly patients with ruptured intracranial aneurysms undergoing craniotomy for clipping. Methods Ninety elderly patients with ruptured intracranial aneurysm were randomly divided into control group and observation group, with 45 cases in each group. The control group was given routine perioperative nursing, and the observation group was given high quality perioperative nursing. The incidence of postoperative complications, length of hospital stay, total cost, clinical prognosis and long-term follow-up were compared between the two groups. Results The complication rate in the observation group was 13.3%, which was significantly lower than 31.1% in the control group(P<0.05). At the time of discharge, the rate of good prognosis in the observation group was significantly higher, the total cost was significantly lower, and the length of hospitalization was significantly shorter than that in the control group(P< 0.05). The Self-Rating Anxiety Scale(SAS)score in the observation group was significantly lower than that in the control group(P<0.05). Conclusion Intensive perioperative nursing for elderly patients with ruptured intracranial aneurysms undergoing craniotomy for clipping can effectively reduce postoperative complications and improve their quality of life.