Objective To compare the clinical effect and safety of surgical clipping versus endovascular coiling in the treatment of unruptured intracranial aneurysms. Methods A computerized search was performed in related databases to obtain controlled clinical trials on unruptured intracranial aneurysms. Two investigators independently selected the articles, extracted data, and performed quality assessment, and then RevMan 5.0 software was used for data processing. Results A total of 21 controlled clinical trials were included, with 109114 cases in total. The meta-analysis showed that compared with the endovascular coiling group, the surgical clipping group had a significantly higher occlusion rate of aneurysms (88.2% vs 65.3%,PUnruptured intracranial aneurysm; Surgical clipping; Endovascular coiling; Meta-analysis<0.05) and a significantly longer hospital stay (7.7 days vs 4.1 days,P<0.05). Compared with the surgical clipping group, the endovascular coiling group had significantly lower short-term mortality rate (0.61% vs 1.27%,P<0.05) and disability rate (2.1% vs 4.7%,P<0.05). There were no significant differences between the endovascular coiling group and the surgical clipping group in 1-year mortality rate (2.5% vs 2.2%,P>0.05) and 1-year disability rate (2.5% vs 1.8%,P>0.05). Funnel plots showed no publication bias, and sensitivity analysis obtained consistent results. Conclusions Compared with surgical clipping, endovascular coiling can shorten the length of hospital stay and reduce the incidence rate of short-term poor prognosis, but it has a lower occlusion rate of aneurysms and a similar 1-year prognosis as surgical clipping. Therefore, patients undergoing surgical clipping may have a better long-term prognosis than those undergoing endovascular coiling, and surgical clipping is more suitable for young patients.