[Giant aneurysms not amenable to direct treatment by ligation of the carotid artery].

Surgical treatment of giant aneurysms are a challenge. Optimal treatment for an intracranial aneurysm is the direct approach, and also clipping the neck of the aneurysm and preservation of the parent vessel. These surgical procedures are not always possible to carry out even with state-of-the-art in neurological surgery. This is the case for giant aneurysms. Carotid ligation remains a good alternative for ophthalmic, intercavernous sinus, and giant aneurysms of the internal carotid artery. We present two patients with unclippable carotid artery aneurysms, one in the intercavernous sinus, and the other in the internal carotid. These were treated by progressive ligature of the carotid artery at the neck. The ligation was done after angiographic and CT scan evaluation. Tolerance to carotid occlusion was evaluated by electroencephalogram and somatosensory evoked potential monitoring, and the procedure was undertaken gradually. Outcome of the two patients was gradual improvement of oculomotor nerve palsy and decrease of ocular pain. These results of treatment and favorable evolution suggest that this treatment is a useful alternative in the management of unclippable carotid aneurysm. Acute or long-term complications were not observed.