We report on a 55-year-old male with an internal carotid artery aneury
sm at the level of the second cervical vertebra. Since anti-coagulatio
n therapy failed to prevent the ischemic attack, aneurysmectomy with a
rterial reconstruction was performed. Vertical mandibular osteotomy al
lowed a wide working space in deep operative field This technique is c
onsidered to be useful in surgery for aneurysms of the extracranial di
stal internal carotid artery.