Cross external carotid ligation for giant aneurysms

Giant aneurysms of the carotid artery commonly produce a visual loss as their main or only clinical manifestation. On occasion they do not respond favorably to ligation of the carotid artery in the neck or even to direct surgical attack on the related carotid artery intracranially. In such cases additional ligation of the contralateral external carotid artery should be considered. Such a case is presented and the rationale for such treatment discussed.