Background <p>Cavernous sinus hemangiomas are rare vascular tumors characterized by significant intraoperative bleeding. Their preoperative diagnosis is challenging and often leads to initial misdiagnosis as other middle fossa lesions, such as tumors or aneurysms.</p> Case presentation <p>We report the case of a 16-year-old Persian male presenting with progressive left-sided visual loss, cranial nerve palsy, with an intracranial lesion originating from the left cavernous sinus, extending into the sella, and occupying half of the middle fossa. He had previously undergone surgery with a preliminary diagnosis of a cerebral aneurysm, but the procedure was aborted owing to excessive intraoperative bleeding. The patient was subsequently transferred to our institution for further intervention. During the second surgical attempt, persistent bleeding and hemodynamic instability necessitated the permanent ligation of the left internal carotid artery to achieve hemostasis. Postoperative pathological examination confirmed the diagnosis of a giant cavernous sinus hemangiomas. Remarkably, the patient exhibited no postoperative neurological deficits. Over a 15-year follow-up period without adjuvant radiotherapy, he remained asymptomatic, with no evidence of tumor recurrence or neurological deterioration.</p> Conclusion <p>The emergent nature of the situation in this case necessitated carotid artery ligation, which was performed without long-term neurological compromise. However, assessing the patient’s tolerance to carotid artery ligation preoperatively is crucial in ensuring a safe outcome. A proactive, well-prepared surgical approach, including thorough preoperative vascular assessment, is essential for optimizing intraoperative safety and plays a pivotal role in managing the risks associated with severe intraoperative bleeding in cavernous sinus hemangiomas cases.</p>