OBJECTIVE: In recent years, there has been a shift toward the endovascular treatment of intracranial aneurysms, particularly among elderly patients, that is, those aged 70 years and older. However, microsurgical clipping remains the preferred modality for aneurysms of a certain morphology and location. The authors of this study aimed to compare the outcomes of clipping on the basis of age. METHODS: This was a retrospective single-center study of patients who had undergone microsurgical clipping of an intracranial aneurysm between February 2016 and November 2022. Propensity scores were estimated using the 1:2 nearest neighbor method. Outcomes of interest were intraoperative and postoperative complications, length of stay (LOS), nonhome discharge (NHD), functional dependence on discharge, and mortality. RESULTS: After propensity score matching, 50 patients older than 70 years were matched with 100 patients younger than 70 years of age. Aneurysm location, morphology, and rupture status were comparable between the matched cohorts. There was no significant difference in complications (14.0% for age ≥ 70 vs 13.0% for age <
70, p >
0.99), extended LOS (30% vs 19%, respectively, p = 0.129), NHD (38.0% vs 26.0%, respectively, p = 0.131), functional dependence on discharge (22% vs 17%, respectively, p = 0.509), or mortality (8.0% vs 2.0%, respectively, p = 0.077). CONCLUSIONS: The study results demonstrated rates of complications, LOS, NHD, functional dependence, and mortality in elderly patients comparable to those in younger patients. The authors acknowledge the importance of patient selection and encourage further studies to assess the safety of clipping in the elderly.