Carotid cavernous aneurysms are distinct entities. The anatomy of the cavernous sinus region has been well defined, and most spontaneous aneurysms of the cavernous sinus region carry a benign prognosis. Progressively symptomatic, traumatic, or infectious aneurysms require treatment. This can be accomplished by carotid occlusion, extra cranial to intracranial bypass, or direct surgery.