【Abstract】Objective To explore treatment options for middle cerebral aneurysm clipping surgery. Methods From June 2014 to june2016，the clinical and radiological data of 121 patients with 147 middle cerebral artery (MCA) aneurysms clipping surgery were retrospectively analyzed. There were 19 aneurysms located at M1 segment of MCA, 95 aneurysms at the main MCA bifurcation and 33 aneurysms at distal MCA. Surgical schemes were selected according to the size of the aneurysm neck and neck wall structure (sclerosis, calcification) of the aneurysms sac, the size of the aneurysm sac, the aneurysm sac thrombosis, calcification and perforation vessels on aneurysm sac. Results 48 aneurysms were treated with clipping surgery and 91 aneurysms were treated with reconstruction clipping. 8 giant aneurysms were treated with aneurysms trapping or proximal artery clipping. At the same time, superficial temporal artery to middle cerebral artery bypass were completed. There were no significant differences in the complication and prognosis of Glasgow between the three methods. The postoperative complications were 10.4%, 14.3% and 12.5%, respectively. The complication rate in patients with reconstructionclipping surgery was higher and the recurrence rate was 3.3%. Conclusion Neurosurgeons should master a variety of surgical techniques, preoperative comprehensive radiographic data detailed analysis. Optimization of surgical program is selected according to the specific circumstances of aneurysm sac. The proper application of different surgical methods of aneurysm clipping is an ideal choice for treating middle cerebral aneurysms.