A giant fusiform aneurysm of the right middle cerebral artery was treated with extracranial-intracranial arterial bypass followed by controlled occlusion of the proximal parent artery using a Drake tourniquet. Thrombosis of the aneurysm is documented, with the distal extremity of the lesion being smoothly contrasted in a retrograde fashion by the hypertrophied bypass. The low risk as well as effectiveness of this combined approach to inaccessible intracranial aneurysms is confirmed.