Objective To explore the clinical effect of microsurgical treatment of intracranial aneurysms and analyze the effect of related factors on the prognosis of cerebral vasospasm (CVS). Methods The clinical data of 128 patients with intracranial aneurysms from May 2009 to May 2013 in our hospital were retrospectively analyzed. We evaluated the clinical effect first, then analyzed the related factors of microsurgery and their effect of postoperative patients with CVS occurred respectively by using single factor and Logistic multifactors. Results Generally, the overall operation effects of the 128 cases were benign, 32 cases (25.00%) occurred CVS postoperatively. Compared with the non-CVS group, the cure rate of CVS group dropped significantly, and mortality rate was considerably increased, the difference was statistically significant (P < 0.05). The single factor analysis showed that the related factors influencing the microsurgery in patients with CVS postoperatively includeing age, Hunt-Hees grading, Fisher's classification, aneurysm location, surgical timing, infection, basic diseases, endplate colostomy, the number of lumbar puncture, blood sugar and white blood cell levels. By Logsitic multi-factor analysis, Hunt-Hees grading, Fisher's classification, aneurysm location, colostomy, lumbar puncture times were found to be the independent factors. Conclusions The general operation effects of microsurgery are benign, Hunt-Hees grading, Fisher's classification,aneurysm location and colostomy, lumbar puncture times and the endplate colostomy are independent risk factors for postoperative intracranial aneurysms occur CVS. Prevent the CVS will be good for the prognosis of patients with intracranial aneurysms.