Objective To investigate the significance and clinical effect of emergency surgical treatment of patients with Hunt-Hess grade V ruptured cerebral aneurysms.Methods Since January 2007, 7 patients with unilateral or bilateral pupil dilation and Hunt-Hess grade V ruptured cerebral aneurysms who were in a coma and did not undergo cerebral angiography were enrolled. According to the bleeding sites on head CT scan, targeted emergency craniotomy was performed to remove the hematoma and clip the aneurysms. The collapse of brain tissue was observed to decide whether to perform decompressive craniectomy or not.Results Of all 7 patients, 1 was cured, 2 were able to take care of themselves, 3 were in a vegetative state, and 1 died after surgery. Among the 3 patients who were in a vegetative state, 2 died of pulmonary infection at 3 months and 1 year after surgery, respectively.Conclusions Emergency surgical treatment of patients with Hunt-Hess grade V ruptured cerebral aneurysms can significantly improve the prognosis of some patients and have a better effect than conservative treatment.