Objective To investigate the clinical effect of early surgical treatment for ruptured intracranial aneurysms with acute neurogenic pulmonary edema.Methods A retrospective analysis was performed for the clinical data of 26 patients with ruptured intracranial aneurysms and acute neurogenic pulmonary edema, and among these patients, 15 underwent early surgical treatment (early surgery group) and 11 underwent conservative treatment (conservative treatment group). The two groups were analyzed in terms of survival rate, re-rupture rate of aneurysms, and arterial blood lactate and oxygenation index (PaO₂/FIO₂) immediately and at 24 hours after admission.Results Compared with the conservative treatment group, the early surgery group had a significantly higher survival rate (73.3% vs 18.2%, P<0.05) and a significantly lower re-rupture rate of aneurysms (6.7% vs 81.8%, P<0.05). The early surgery group had a significant reduction in arterial blood lactate and a significantly lower level of arterial blood lactate than the conservative treatment group at 24 hours after admission (P<0.05). The early surgery group had a significant increase in PaO₂/FIO₂ at 24 hours after admission, as well as a significantly higher PaO₂/FIO₂ than the conservative treatment group (P<0.05).Conclusions Early surgical treatment can significantly reduce the re-rupture rate of intracranial aneurysms and the level of arterial blood lactate, increase oxygenation index, and improve the survival rate of patients with ruptured intracranial aneurysms and acute neurogenic pulmonary edema.