Objective To explore the clinical value of endovascular surgery guided by 3D-DSA combined with overlay navigation for intracranial aneurysms and assess its impact on patient prognosis. Methods A retrospective analysis was conducted on 100 patients who underwent endovascular treatment for intracranial aneurysms in First Affiliated Hospital of Naval Medical University from January 2021 to December 2024. Patients were divided into a combined group (n=50) and a non-combined group (n=50) based on whether overlay technology was used intraoperatively. Perioperative parameters (operative time, hospitalization duration, intraoperative contrast agent dosage, radiation exposure), aneurysm occlusion degree, and postoperative complications (transient hemorrhage, vasospasm, hydrocephalus, intracranial infection) were compared between the two groups. A 6-month follow-up was conducted, and patient outcomes were evaluated using the modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS). Results The combined group exhibited significantly shorter operative and hospitalization times, as well as reduced intraoperative blood loss, contrast agent usage, and radiation exposure compared to the non-combined group (P<0.05). Aneurysm occlusion degree was significantly better in the combined group (P<0.05). No significant difference was observed in postoperative complication rates between the two groups (P>0.05). At 6 months post-surgery, the combined group demonstrated superior mRS and GOS scores compared to the non-combined group (P<0.05).Conclusion Endovascular surgery guided by 3D-DSA combined with overlay navigation can shorten operative and hospitalization times, reduce contrast agent dosage, and radiation exposure, while achieving favorable clinical outcomes with acceptable safety for patients with intracranial aneurysms