From May 2004 to August 2009, we treated 28 cases of internal carotid artery segmental aneurysms, of which large + giant aneurysms accounted for 66% (20/30) of the total. 66.7% (20/30). The surgical methods include direct clamping, partial aneurysm resection + reconstruction of the aneurysm-carrying artery, intracranial and extracranial artery bypass grafting + aneurysm resection with aneurysm-carrying artery shaping or isolation, etc., which have achieved more satisfactory results. The clinical characteristics and surgical difficulties are analyzed as follows in the light of the literature.