Surgical clipping has been considered for years a "golden standard" in the treatment of middle cerebral artery (MCA) aneurysms. The recent development of materials and endovascular techniques has permitted the use of embolization for the treatment of intracranial aneurysms regardless of their locations and size. In 30 patients with 32 MCA aneurysms (group I) the endovascular approach with GDC-10 coils was used, while in other 30 patients with 31 aneurysms (group II) surgical clipping was performed. On completion of the diagnostic process the patients were randomly assigned either to the endovascular or microsurgical treatment. Group I: 21 (70%) embolization procedures were carried out, while in 9 (30%) cases with 10 aneurysms embolisation was impossible or regarded as too risky due to various causes. The total occlusion of aneurysm SAC was achieved in 17 (77%) aneurysms, subtotal in 5 (23%). The morbidity rate was 8%, mortality-0%. Group II: Microsurgical clipping was performed in 27 (90%) cases, 3 (10%) patients were disqualified from treatment due to their poor clinical status. An excellent technical result was achieved in 24 (86%) patients, in 4 (14%) cases the neck remnant was observed in control angiography. The morbidity rate was 14%, mortality-0%.