Abstract

Carotid ligation was the first ever treatment modality for Internal Carotid Artery (ICA) aneurysm. Since then, various other surgical clipping and coiling techniques have developed. We revisited the “awake” carotid ligation technique in a 59-year-old lady with a left giant ICA aneurysm, requiring intraoperative neurological testing. Ultrasound-guided superficial cervical plexus block (SCPB) was ideal and the cornerstone of the anesthetic technique. The ultrasound guidance was used to precisely guide injection and provide excellent analgesia, in a cooperative, arousable patient. Good preoperative counseling played an equally important role in the successful conduct of this challenging case, with a good outcome.