Paraclinoid internal carotid artery aneurysms originate from the internal carotid artery between the distal dural ring and the posterior communicating artery. Surgical treatment of these aneurysms is technically challenging because of the surrounding neurovascular structures. These lesions can be treated using several different methods, each of which has its advantages and disadvantages. Direct clipping methods were developed for paraclinoid ICA aneurysms, which includes suction decompression of giant aneurysms to deflate the aneurysm and improve dissection. Furthermore, intraoperative monitoring of electrophysiology and blood flow is indispensable for minimizing complications. The electrophysiology can be monitored with somatosensory-evoked potentials, motor-evoked potentials, and visual-evoked potentials; blood flow can be monitored with a Doppler flow meter, intraoperative angiography, and intraoperative indocyanine green videoangiography. In order to treat paraclinoid aneurysms, it is necessary to use a combination of these intraoperative monitoring techniques, in addition to gaining information on the anatomy, size, collateral flow pattern, and patient age. Surgical treatment of large and giant paraclinoid ICA aneurysms are technically challenging for many neurosurgeons. RSD greatly facilitates surgical clipping for large and giant paraclinoid ICA aneurysms. Visual preservation and improvement occur in the majority of these cases, which are important outcome measures