Petrous internal carotid aneurysm (PA) concomitant with a mass lesion and cranial nerve palsy is relatively rare. In recent years, flow-diverter stent implantation is being widely used as an alternative treatment for PA. However, alternative treatments are not available for all patients for various reasons, including the tortuosity of the parent carotid artery, allergies to contrast material, or high cost. It is, therefore, important to compare the relative outcomes of different treatment

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... ent treatment methods. Here, we have accordingly reviewed the available literature on the treatments for PA. We searched PubMed, MEDLINE, and other databases, such as OvidSP using the terms "aneurysm ", "carotid artery", and "petrous " and identified 221 articles. We also performed a literature review and discussed and compared the etiologies, symptoms, treatment methods, and clinical outcomes in patients with PA. The systematic review revealed that the onset of secondary aneurysms was generally manifested by bleeding (p<0.001), while the onset of primary aneurysms was manifested by cranial nerve deficits (p= 0.0014); the prognosis after treatment of 34 cranial nerve palsies in 25 cases was reported.