Middle cerebral artery (MCA) aneurysms account for approximately one-fifth of aneurysmal subarachnoid hemorrhage. The preferred treatment of these aneuryms is microsurgical clipping because of their peripheral location, large neck-to-fundus ratio, incorporation of major branches into the aneurysmal wall, and high incidence of intracerebral hematoma. MCA aneurysms can be approached surgically using one or two of three basic techniques; medial transsylvian, lateral transsylvian and superior temporal gyrus approach. In this presentation, selection of surgical approaches and the surgical techniques to minimize the neurovascular structures are described. Management outcomes by using these techniques is also presented.ope
