Giant cerebral aneurysms may be untreatable by conventional neurosurgical techniques. Early attempts to use circulatory assistance and deep hypothermia were abandoned due to hemorrhagic complications. More recently, interest in circulatory support for complex neurosurgical procedures has been renewed. A consecutive series of 8 patients were operated on for giant cerebral aneurysms with the combined use of deep hypothermia. The protocol included careful preoperative cardiovascular assessment, perfect intraoperative synergy between neurosurgical and cardiac teams, minimally invasive peripheral vascular access including two femoral vein (21 F) and single arterial (17 F) femoral cannulation, use of total Carmeda coating on BioMedicus pumps in closed circuits, and reduced heparinization without Protamine reversal. All cerebral aneurysms were successfully treated through deep hypothermia (15-18 degrees C) as assessed by intraoperative fluoroscopic controls and Doppler vascular assessment. Mean circulatory support time was 174.2 +/- 29.6 min. Circulatory arrest period was 20 +/- 12 min. All patients survived and were extubated within 48 h. No major deficit was observed clinically or on postoperative CT scan. No hemorrhagic complications occurred (mean transfusions was 2.2 blood units). This work supports an extensive use of heparin-coated surfaces for complex circulatory assist techniques, either for cardiac or extra cardiac complex procedures.