Background <p>The objective of this study was to determine whether sevoflurane or propofol would affect the immune inflammation response and neuroprotective potential after endovascular coiling for cerebral aneurysms.</p> Methods <p>This prospective cohort study enrolled 80 patients with aneurysmal subarachnoid hemorrhage undergoing endovascular coiling. Patients were divided into two groups: the sevoflurane group (<i>n</i> = 40) and the propofol group (<i>n</i> = 40). The primary clinical outcome was the level of anti-inflammatory factor IL-10 after surgery. Neuroprotection was assessed through neuronal injury marker S100-β and the balance between pro- and anti-inflammatory cytokines, while delayed cerebral ischemia (DCI) was evaluated as a clinical outcome measure of ischemic brain injury. Blood samples were collected at admission (T0) and 24&#xa0;h postoperatively (T1) to measure neuroinflammatory biomarkers (IL-10, IL-1β, IL-6, IL-8, TNF-α, and S100-β). Given baseline imbalances in IL-8 and TNF-α between groups, we employed analysis of covariance (ANCOVA) with baseline values as covariates, and ΔT1–T0 to account for repeated measures and within-subject correlations.</p> Results <p>The T1/T0 ration of L-10, IL-1β, IL-6, IL-8, TNF-α, and S100-β was 1.00(0.62, 2.86), 1.00(0.62, 2.86), 3.42(0.36, 17.4), 1.42(0.34, 12.14), 1.29(0.57, 7.75), 1.12(0.25, 2.76), respectively in propofol group and 1.00(0.80, 2.64), 1.00(0.65, 2.82), 2.70(0.31, 31.75), 1.78(0.37, 53.60), 1.34(0.44, 13.31), 1.11(0.08, 12.26), respectively in sevoflurane group (<i>P</i> = 0.293, 0.072, 0.810, 0.939, 0.939, and 0.722). Postoperative outcomes including GCS, incidence of DCI related infarcts (propofol 12.5% vs. sevoflurane 15.0%, <i>P</i> = 0.747), and length of hospital stays were similar between groups. However, the sevoflurane group had higher hospital costs compared to the propofol group (170,947 ± 4,921 vs. 149,817 ± 6,097 yuan, <i>P</i> = 0.031).</p> Conclusions <p>Both sevoflurane and propofol demonstrated comparable effects on systemic inflammatory biomarkers, neuronal injury markers, and DCI incidence in patients undergoing endovascular coiling for cerebral aneurysms after adjusting for baseline differences. The study indicates that the impact of anesthesia on immune inflammation response, neuronal injury marker, and early clinical events may be limited, and other factors such as patient characteristics and surgical variables may play a more significant role.</p> Clinical trial registration <p>Identified as NCT06666959 at <a href="http://www.clinicaltrials.gov">www.clinicaltrials.gov</a>.</p>