BACKGROUND: Middle cerebral artery aneurysms (MCAAs) account for about 20% of intracranial aneurysms. These are commoner in females and have various other special features. AIM: To study the demographic features in a subset of South Indian Population and to assess the clinical and radiologic parameters of outcome. PATIENTS AND METHODS: Retrospective analysis of 99 patients with diagnosis of symptomatic MCAAs admitted to Sri Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India from 2000 to 2004 was performed. Clinical features and radiologic parameters were analyzed and correlation with outcome was evaluated. Fishers exact test and Pearson analysis was used for statistical analysis. RESULTS: Seizures and hemiparesis were common clinical findings. Hydrocephalus was less often seen and aneurysms pointing laterally had high incidence of parenchymal hematomas. Mirror, giant, and multiple aneurysms were often seen. CONCLUSIONS: MCAAs have higher association of multiple aneurysms, incidence of angiographic vasospasm is very high, and it significantly influences outcome besides preoperative World Federation of Neurological Surgeon and future directions to improve the surgical results should be aimed to better deal with the vasospasm and its sequelae. © 2008 by Lippincott Williams & Wilkins.