This paper presents a computational vascular fluid-structure interaction (FSI) methodology and its application to patient-specific aneurysm models of the middle cerebral artery bifurcation. A fully coupled fluid-structural simulation approach is reviewed, and main aspects of mesh generation in support of patient-specific vascular FSI analyses are presented. Quantities of hemodynamic interest such as wall shear stress and wall tension are studied to examine the relevance of FSI modeling as compared to the rigid arterial wall assumption. We demonstrate the importance of including the flexible wall modeling in vascular blood flow simulations by performing a comparison study that involves four patient-specific models of cerebral aneurysms varying in shape and size.