N UMEROUS reports have indicated the value of carotid occlusion in the neck for treatment of intracranial aneurysms. [1][2][3][4]6 Recent studies have included an investigation of the pressure changes and blood flow after carotid occlusion, s and a postoperative angiographic study of the end results of ligation. 7 This paper will report the results of 40 carotid ligations performed during a 30-year period by one neurosurgeon (J.G.L.). Material and MethodClinical Records. All patients with mtracranial aneurysms treated by carotid ligation from 1936 through 1965 were reviewed. Patients whose current follow-up information was inadequate were queried in person or by correspondence for additional inforination.Operative Technique. From 1936From through 1946, ligation of the internal carotid artery in the neck was employed. After 1946 and until 1955, the common carotid artery was ligated, the procedure being followed by liga-*ion of the internal carotid artery approximately 1 week later. Ligation of the common carotid artery alone was performed from 1956 through 1965. With rare exceptions, all surgical procedures were done with the patient awake and under regional (deep cervical block) or local infiltration anesthesia, or both. The artery to be ligated was first temporarily occluded for ~0 to 30 minutes with a bulldog clamp, and the patient's general reactions, motor function, response to questioning, and ability to perform simple calculations were evaluated. If no untoward results were noted, the artery was doubly ligated with silk "fishline" ties; the distal tie was tightened to occlude the lumen but not to break the intima, and the proximal ligature was purposely tightened to crack the intima.

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