OBJECTIVE The incidence rate of aneurysmal subarachnoid hemorrhage (SAH) in the elderly is increasing. Although endovascular coiling has become a major form of treatment for SAH in elderly patients, not all ruptured aneurysms can be managed with an endovascular approach. Conventional surgical clipping still plays an important role in SAH treatment. The present study was performed to assess the outcome in patients older than 75 years of age in whom ruptured aneurysms were treated by clipping surgery. METHODS This retrospective study included patients 75 years of age or older who underwent clipping surgery for ruptured cerebral aneurysms between 1988 and 2009. Age, gender, preoperative grade, Fisher grade, size, and location of the ruptured aneurysm were compared between cases showing favorable and unfavorable outcomes. RESULTS A total of 333 patients were analyzed. There were significant differences in preoperative grade, Fisher grade, and location of the aneurysm between the favorable and unfavorable outcome groups. In multivariate logistic regression analysis, independent predictors of unfavorable outcome were poor grade and ruptured anterior cerebral artery aneurysm, but not age of 80 years or older. CONCLUSIONS Advanced age did not represent a risk factor for poor outcome of clipping surgery in elderly patients. Although coil embolization has been shown to be a useful form of treatment, direct surgery should also be considered.