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Introduction: Aneurysms superiorly located on the proximal segment of the middle cerebral artery (PMCAA) are rare and challenging to treat. No information is available regarding their management by endovascular approach. The aim of this study was to report our experience with endovascular treatment (EVT) of PMCAA. Methods: A retrospective review of our prospectively maintained database identified all PMCAA treated in our institution. The clinical charts, procedural data, and angiographic results were reviewed. Results: From April 2004 to December 2011, 17 patients were identified including six who presented with subarachnoid hemorrhage (SAH) and 11 with an unruptured PMCAA. All aneurysms were small (<6 mm) and had a branch arising from the neck or the sac, and 15/17 were wide-necked. All patients were successfully treated by balloon-assisted coiling ( n = 10), stent-assisted coiling ( n = 5), and coiling ( n = 2). No technical or clinical complication occurred. Fifteen patients showed an excellent clinical outcome, and two kept a slight or a significant deficit that were both SAH-related. Immediate anatomical outcome includes nine complete occlusions and eight neck remnants. Imaging follow-up in 11 patients (mean = 21, range, 6 to 60 months) showed stable or improved results in all cases. Conclusion: Our study is the first reported series of patients with PMCAA treated by selective embolization. It suggests that EVT is a safe and effective alternative to surgery for the management of PMCAA. Balloon- or stent-assisted coiling are needed in most cases because of PMCAA morphological characteristics. [ABSTRACT FROM AUTHOR]