Objective To investigate the effect of surgical methods on epileptic seizure and its relationship with bleeding severity and outcome of patients with ruptured intracranial aneurysms.Methods A retrospective analysis was conducted on the clinical data of patients with ruptured intracranial aneurysms who underwent a surgery at the Department of Neurosurgery in our hospital from May 2013 to May 2017. According to the surgical methods, the patients were divided into clipping group and coiling group. Baseline characteristics, complications, and outcomes were compared between the two groups; meanwhile, the incidence of epileptic seizure and outcomes of the patients were compared based on their clinical grades.Results A total of 363 patients underwent a clipping operation and 211 patients underwent a coiling operation. There was no significant difference in the incidence of epileptic seizure between the two groups (P=1.000), but the incidence of epileptic seizure was significantly higher in the clipping group for patients classified as Hunt-Hess grade 1-3 and modified Fisher grade 1-2 (P=0.036;P=0.013). In the patients classified as Hunt-Hess grade 1-3 and modified Fisher grade 1-2, a worse outcome was observed for those with a epileptic seizure compared with those without (P=0.010;P=0.031).Conclusions After undergoing either of the above two types of surgeries, there was no significant difference in the incidence of epileptic seizure between patients with ruptured intracranial aneurysms; however, a clipping operation results in a higher incidence of epileptic seizure in patients with low clinical grades, and is associated with poor outcomes.