Surgical management of giant cerebral aneurysms remains a major techni
cal challenge for modern neurosurgeons. Endovascular approaches for gi
ant aneurysms does not provide an acceptable alternative to direct sur
gical approaches. The use of deep hypothermic circulatory arrest as an
adjunct during clipping of complex giant aneurysms shows promise as a
treatment for otherwise incurable lesions. Patient selection and tech
niques of circulatory arrest surgery are discussed.