BACKGROUND: Intracranial aneurysms, characterized by focal arterial wall dilation, pose significant neurosurgical challenges due to their potential for rupture and hemorrhage, leading to severe clinical outcomes, including fatality. Patients often experience profound psychological and social impacts, such as depression, anxiety, and cognitive impairment, affecting their quality of life. Rapid progression and high mortality necessitate timely intervention. Advances in neurosurgical techniques, including microscopic surgery and neuroendoscopy, offer distinct advantages. Microscopic surgery provides precision and direct visualization, while neuroendoscopy ensures minimally invasive access and reduced tissue trauma. Integrating these methods optimizes treatment efficacy and clinical outcomes. AIM: To evaluate the impact of combined microscopic and neuroendoscopic techniques on psychological, cognitive outcomes, and quality of life in patients with ruptured intracranial aneurysms. METHODS: The study focused on 189 patients with intracranial aneurysm rupture and hemorrhage from January 2020 to May 2024 as the objects of observation and analysis. They were randomly divided into a control group (treated with simple microscope surgery, RESULTS: Before treatment, the depression and anxiety scale scores, cognitive function assessment results and quality of life assessment data of the two groups of patients at different time points were compared, and there was no statistically significant difference ( CONCLUSION: Surgical treatment combined with microscopy and neuroendoscopy has a significant positive effect on the mental health, cognitive function and overall quality of life of patients with intracranial aneurysm rupture and bleeding, can shorten the operation time and treatment time, and provides a new strategic reference for clinical treatment.