Sixty-nine elderly patients over 65 years old with ruptured aneurysms had a significantly worse outcome than 192 younger patients with respect to overall management results and operative results (p less than 0.01). The results of an early operation were better in the elderly patients with grade I-III than in those receiving a delayed operation. Concomitant diseases significantly influenced the results in elderly patients (p less than 0.05). It is possible that an early operation results in the better outcome in elderly patients by decreasing the incidence of delayed ischemic complications and preventing rebleeding.