Objective To compare the effect of microsurgical clipping and interventional embolization on perioperative cerebral oxygen metabolism and short-term prognosis in patients with intracranial aneurysm.Methods Thirty-six patients with intracranial aneurysm scheduled for selective operation were divided into group A （microsurgical clipping treatment， 18 patients） and group B （interventional embolization treatment， 18 patients） according to different operation methods. After retrograde catheterization through the internal jugular vein， peripheral arterial blood and transverse sinus venous blood were taken at four time points for blood gas analysis： immediately after anesthesia catheterization （T1）， before aneurysm treatment （T2）， immediately after aneurysm treatment （T3）， and after operation （T4）. The cerebral oxygen metabolism indicators and prognosis were monitored and compared between the two groups.Results Compared with T1 within group B， the transverse sinus venous oxygen saturation at T4 was decreased significantly， and the arterial lactic acid concentration was increased significantly （P <0.05）. Compared with group A， the corresponding arteriovenous oxygen content difference and cerebral oxygen extraction rate at T2 in group B were increased significantly， and the postoperative admission to intensive care unit， postoperative hospital stay， and related invasive procedures were significantly reduced （P <0.05）. The modified Rankin scale score of group B was significantly better than that of group A within 6 months after discharge （P <0.05）.Conclusions Compared with microsurgical clipping for intracranial aneurysm， interventional embolization has a significant influence on the balance of cerebral oxygen supply and demand during the operation， but brings patients better short-term prognosis. ［Journal of International Neurology and Neurosurgery, 2022, 49(6): 23-28］