Objective To investigate the effect of different treatment methods such as microsurgical aneurysm clipping and endovascular embolization on the treatment outcome of aneurysmal oculomotor nerve palsy （OMNP）.Methods A retrospective analysis was performed for the clinical treatment and follow-up results of 25 patients with intracranial aneurysm and OMNP who were admitted to The First Affiliated Hospital of Xinjiang Medical University from January 2018 to October 2020， and postoperative recovery of oculomotor nerve function was compared between the patients undergoing microsurgical aneurysm clipping and those undergoing intravascular embolization， as well as between the patients with different severities of OMNP before surgery.Results For all 25 patients， the mean length of hospital stay was 9.72±3.82 days after surgery； at discharge， 3 patients （12.0%） achieved complete recovery of OMNP symptoms， 10 （40.0%） achieved partial recovery， and 12 （48.0%） had no recovery， and no aggravation was observed. Of all 25 patients at the 6-month follow-up after surgery， 6 （24.0%） achieved complete recovery of OMNP symptoms， among whom 2 underwent embolization and accounted for 20% （2/10） of the embolization group and 4 underwent clipping and accounted for 28.6% （4/14） of the clipping group； 10 （40.0%） achieved partial recovery， among whom 5 underwent embolization and accounted for 50% （5/10） of the embolization group and 5 underwent clipping and accounted for 35.7% （5/14） of the clipping group； 9 （36.0%） had no recovery， among whom 3 underwent embolization and accounted for 30% （3/10） of the embolization group and 5 underwent clipping and accounted for 35.7% （5/14） of the clipping group.Conclusions Both microsurgical aneurysm clipping and endovascular embolization can improve aneurysmal OMNP.