Controversy still exists as to the best mode for treating middle cerebral artery (MCA) aneurysms. Surgical clipping remains the optimal treatment in many institutions. With the progression of endovascular technique and devices, the safety and efficacy of endovascular treatment of MCA aneurysms have been further improved and endovascular approach has become an acceptable alternative. This review discussed the recent progress on endovascular treatment of MCA aneurysms and assessed its safety and effectiveness, hoping to provide evidences for neurointerventionalists to select appropriate therapies.