A case of aneurysm of the left internal acoustic meatus has been reported. The patient was 53-year-old man who was admitted with the history of sudden onset of a severe occipital headache 18 days previously. He also noted nausea, vomiting and became drowsy at that time. He was seen at a local clinic and a lumbar puncture showed bloody fluid. The next day his level of consciousness improved but he noted left tinnitus and neck stiffness. On admission, he only complained of a left tinnitus. The rest of the neurological examination was normal. Craniogram was of no abnormal findings. Cerebral angiogram showed an aneurysm at the left internal acoustic meatus fed by the left internal auditory artery. At operation, the aneurysm was clipped at the entrance of its feeding artery via retroauricural-retromastoidal craniectomy. The postoperative course was satisfactory except for the decrease of the left auditory acuity to 50dB. Postoperative angiogram revealed a complete disappearance of the aneurysm. In the literature only six cases have been reported, which were summarized in Figure 1. Clinical features of such an aneurysm are subarachnoid hemorrhage and symptoms of cerebello-pontine angle, namely tinnitus, hearing disturbance and facial palsy etc. Besides, on skull x-ray film, sometimes enlargement of the internal acoustic meatus has been found.