Direct surgical repair of technically difficult or otherwise inoperable vascular lesions of the brain may become possible or safer using profound hypothermia and circulatory arrest. Most surgeons who use this technique establish extracorporeal circulation by cannulating the femoral vessels. To avoid difficulties associated with this closed chest method, a method was devised to establish extracorporeal circulation, profound hypothermia, and circulatory arrest by direct cannulation of the right atrium and aorta through the chest. This technique is described in a patient whose otherwise inoperable vertebral artery aneurysm was successfully treated. This approach is simple and offers several advantages over the closed chest method.