“…The treatment of choice should be fitted to every patient and needs. Surgical options embody ligation, extracranial to intracranial bypasses (which has been left as meer anecdotal or in life threatening scenarios) 10,11 , resection and reconstruction using autologous or prosthetic grafts for tortuous ECAA aneurysms allow resection and a primary end-to-end anastomosis 1,4,8,12 . Endovascular therapy may be advantageous for selected cases 8,9 , reducing cranial nerve injuries and periprocedural complications, although due to the anatomical features of the aneurysms, open surgery still remains to be the standard procedure 1,3,13 .…”