Although the surgical technique of the management of an middle cerebral artery(MCA) aneurysm is not more difficult than that of an aneurysm in any other location, the surgical management outcome of this aneurysm is not better than that of other location aneurysms. This is probably due to occurrence of an intracerebral hemorrhage more frequently in an MCA aneurysm than other location aneurysms. This is required the proper surgical management of this aneurysm to be reviewed. The key points of surgery for MCA aneurysm can be summarized as follows: gently wide dissection and splitting of the sylvian fissure without injury of main sylvian veins; early adequate exposure of the M1 sites for temporary clips applications; avoid injuries of small branches of the MCA in sylvian fissure by using a low pressure suction during removing the intrasylvian hematoma; avoid injury of lenticulostriate arteries and narrowing of the parent arteries during clipping of aneurysms; and successful aneurysm obliteration with minimal brain retraction. Preoperative imagination of the configulation of aneurysm and the relationship between the aneurysm and surrounding vessels, such as M1, M2 and lenticulostriate arteries, from angiographic informations will decrease the incidence of premature aneurysmal ruptureduring surgery and improve the surgical management outcome of patients with MCA aneurysm. From September 1982 to December 1998, the authors has surgically treated 1025 patients of the cerebral aneurysms. Among these patients, 274 patients(26.7%) had the MCA anurysms. The surgical outcomes of these MCA aneurysm patients were good in 222 patients(81.0%) and death in 22 patients(8.0%). The authors discusses surgical anatomy and techniques for the management of MCA aneurysms on the basis of the author's experiences and a review of the literatures in order to improve the surgical management outcomes of patients with MCA aneurysm in the future.