BACKGROUND: Direct surgery or endovascular procedures are an accepted way of treating patients with Aneurismal Subarachnoid Haemorrhage (SAH). However the impact of invasive methods of treatment on results in developing countries may differ from that in developed countries.    METHODS: This is a prospective clinical study of consecutive patients with Subarachnoid Haemorrhage (SAH) admitted in Ghaem hospital in Mashhad during 2005-2010. The initial diagnosis and investigations were carried out by neurologists. The patients were divided into two groups. One received surgical treatment whilst the other group was managed medically. The decision as to the choice of method of treatment was made by the neurosurgeons. The initial medical treatment was standardised for all the patients. The rate of complications and mortality was compared in both medical and surgical groups.    RESULTS: 120 SAH patients (52% females) with a mean age of 50.6 ± 7 years were evaluated. The angiography revealed the presence of an aneurysm in 62 patients. 63.5% of patients received medical treatment and 37.5% underwent aneurysmal surgery. Difference of rebleeding rate in two therapeutic groups was not significant; χ2 = 0.014, P = 0.91. The effect of rebleeding on mortality was not significant; χ2 = 2.54, P = 0.14. Within 62 SAH patients with cerebral aneurysm, the mortality rate in both therapeutic groups was also not significantly different; χ2 = 0.16, P = 0.77.    CONCLUSION: There is no significant difference in the mortality rate between the “surgical” and non “surgical” groups of patients with SAH. This could be due to delay in performance of surgery in neurovascular centers in Iran.Keywords: Mortality, subarachnoid, surgery, haemorrhage.