Extracranial internal carotid artery aneurysms are uncommon. The symptoms of these aneurysms vary according to their location and size. Larger aneurysms may present as cervical or parapharyngeal masses, which may or may not be pulsatile or tender; there may be an associated systolic bruit. Pharyngeal hemorrhage, epistaxis, or bleeding from the ear are rare manifestations. Ischemic symptoms are a frequent mode of presentation of these aneurysms. Arterial diseases, particularly atherosclerosis, may predispose the vessel to the formation of the aneurysm. Sometimes trauma is the cause. We report herein six cases of extracranial internal carotid artery aneurysms. The modes of presentation, the etiologic factors, the pathologic observations, and the methods of management are discussed, and the pertinent literature is reviewed.