In this case report, we describe the first reported case of treating a 7-year-old male patient who has a giant, fusiform aneurysm confined to the inferior M2 segment by means of a saphenous vein graft. Given the lack of good endovascular management options for this particular scenario, craniotomy was recommended and an end-to-side ECA-ICA anastomosis was carried out with technical details of the surgery outlined in the manuscript. The patient did not sustain any major postoperative complications. The graft remained patent upon completion of the surgery and at the time of last follow-up, 9 months post-surgery. This case serves as an illustrative example of the need for high-flow bypass for a select few patients even as endovascular technology continues to improve.