A 42-year-old female sustained a partial transection of the internal carotid artery at the base of the skull from a stab wound of the external ear. The clinical presentation and technical aspects of the surgical treatment are presented. The lesion could not be repaired and was successfully treated by ligation. The various techniques of operative exposure of challenging and unusual high carotid injuries which can be employed to eliminate the risk of cerebral embolism, false aneurysm formation, or carotid artery thrombosis associated with conservative management are reviewed.