Objective : This study is aimed to assess the clinical outcome in early and minimally invasive surgery using incision for the patients with poor grade aneurysm. Methods : The authors retrospectively reviewed all 46 poor grade patients of Hunt and Hess[H-H] grade IV and V who suffered aneurysmal subarachnoid hemorrhage[SAH] between 1999 and 2004. All 35 patients harboring 43 aneurysms who underwent early surgery within 72 hours were included in this study. Clinical outcome was assessed by Glasgow outcome scale[GOS] and compared with that of conventional pterional approach. Results : Twenty four patients were operated with conventional pterional approach and 11 with eyebrow approach within 72 hours after SAH. Seven multiple aneurysm patients harbor 15 aneurysms, Forty one aneurysms were treated with clippings. All 11 patients of eyebrow surgery group[ESG] were in H-H grade IV, 3 in Fisher grade III and 8 in Fisher grade IV. Among 24 patients of pterional approach group[PAG]. 20 were in H-H grade IV and 4 in H-H grade V, 3 were in Fisher grade III and 21 in Fisher grade IV. Overall favorable outcome was achieved in 41.7% and 54.5% in PAG and ESG, respectively. Favorable outcome of H-H grade IV in PAG showed 45.0%. Overall mortality rate was 14.3%. Conclusion : It is concluded that the clinical outcome of early and minimally invasive aneurysmal surgery using eyebrow incision in the selected poor grade aneurysm patients can be compatible with that of conventional pterional surgery.