目的　探讨大脑中动脉 (MCA)动脉瘤的局部解剖、影像学表现、临床特点及手术技巧。方法　回顾性分析 2 1例MCA动脉瘤的临床资料 ,19例有破裂出血的临床表现 ,偏瘫 5例 ,失语 3例 ,癫痫 6例。动脉瘤位于M1段 2例 ,M2 段 18例 ,M3 段 1例。巨大动脉瘤 4例。动脉瘤夹闭 12例 ,动脉瘤切除 4例 ,夹闭 +包裹 5例 ,其中 1例巨大动脉瘤 (直径 7cm)切除后同时行MCA端 端吻合。结果　CT显示动脉瘤破裂出血表现为 :①局限或弥散性蛛网膜下腔出血 11例 ;②脑内血肿 4例 ;③外侧裂血肿 2例 ;④血肿破入脑室 2例。巨大动脉瘤在CT或MRI上表现为颞叶或中颅窝占位 ,呈现病灶中心明显强化、流空现象或靶环征。优良 19例 ,中残 2例 (术前为Ⅳ级 )。结论　熟悉MCA的局部解剖 ,有助于减少术中豆纹动脉损伤和术后神经功能障碍 ;对合并脑内血肿的Ⅲ级以上的MCA动脉瘤 ,应急诊手术清除血肿和夹闭动脉瘤 ,预后常较好 Objective To investigate the anatomy, imaging features, clinical features and surgical skills of middle cerebral artery (MCA) aneurysms. Methods A retrospective analysis of 21 cases of MCA aneurysm clinical data, 19 cases of clinical manifestations of bleeding, hemiplegia in 5 cases, 3 cases of aphasia, epilepsy in 6 cases. The aneurysms were located in M1 segment in 2 cases, M2 segment in 18 cases and M3 segment in 1 case. 4 cases of giant aneurysm. Aneurysm occlusion in 12 cases, aneurysm resection in 4 cases, occlusion + package in 5 cases, of which 1 case of giant aneurysm (diameter 7cm) after resection of MCA end anastomosis. Results CT showed aneurysm rupture bleeding as follows: ① localized or diffuse subarachnoid hemorrhage in 11 cases; ② intracerebral hematoma in 4 cases; ③ lateral hematoma in 2 cases; ④ hematoma ruptured into the ventricle in 2 cases. Huge aneurysm in the CT or MRI showed temporal lobe or middle cranial fossa occupy, showing focal lesions were significantly enhanced, empty phenomenon or target ring sign. Excellent in 19 cases, 2 cases of residual (preoperative grade Ⅳ). Conclusion Familiar with the local anatomy of MCA, help to reduce intraoperative arteriolar artery injury and postoperative neurological dysfunction; for intracranial hematoma grade â ... ¢ MCA aneurysm, emergency surgery to remove the hematoma and aneurysm clip, the prognosis Often better