Objective To observe the clinical efficacy of surgical options and endovascular in treatment of middle cerebral artery aneurysm. Methods A total of 102 patients with middle cerebral artery aneurysm were randomly divided into the surgical options group and the endovascular group, 51 cases in each group. The rate of complete occlusion, recurrence and complications, hospital length, hospital expense and postoperative recovery were compared between the two groups. Results There was no significant difference in the rate of complete occlusion and recurrence rate between the surgical options group and endovascular group (P?>?0.05); the patients of the surgical options group had significantly higher rate of complications than the endovascular group (P?