Subtemporal approach to basilar bifurcation aneurysms: advanced technique and clinical experience.
OBJECTIVE
The surgical treatment of basilar bifurcation aneurysms is challenging, and many of these aneurysms are currently treated by endovascular means. However, the complete closure of the aneurysm by surgical clipping still remains the best and most permanent cure for the aneurysm. The "gold standard", subtemporal approach was established and introduced by Drake and it has been adapted by the senior author Hernesniemi. We describe our present modified technique of this approach based on clinical experience.


METHODS
The subtemporal approach to basilar bifurcation aneurysms has been regularly used by the senior author Hernesniemi in recent 15 years in over 200 operations in Kuopio and Helsinki, Finland.


RESULTS
This approach is suitable in most basilar bifurcation aneurysms except for those high above the posterior clinoid process. To avoid temporal lobe damage, cerebrospinal fluid drainage is necessary. Benefits of subtemporal approach are short operative and retraction times, and no need for skull base resection.


CONCLUSIONS
The subtemporal approach is simple and safe in experienced hands, and should be considered the standard method to approach most basilar bifurcation aneurysms.
Hernesniemi
J
J
Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland. juha.hernesniemi@hus.fi
Ishii
K
K
Niemelä
M
M
Kivipelto
L
L
Fujiki
M
M
Shen
H
H
D001488:Basilar Artery / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000639:trends