title: Subtemporal approach to basilar tip aneurysm with division of posterior communicating artery: technical note.
abstract: The subtemporal approach with division of the posterior communicating artery (PcomA) is described for treating aneurysms of the basilar tip. When the ipsilateral posterior cerebral artery (PCA) interferes with visibility and manipulation around the aneurysm neck and the artery is tethered by the PcomA and not mobilized, the PcomA can be divided near the junction with the PCA. The procedure permits PCA mobilization and exposes the neck of the aneurysm. We applied this procedure to a patient with a ruptured aneurysm of the basilar tip. The postoperative course was uneventful except for transient left oculomotor nerve palsy. Postoperative cerebral angiography and magnetic resonance imaging confirmed the respective disappearance of the aneurysm and no new ischemic lesions. The subtemporal approach allows safer and easier division of the PcomA near the junction to the PCA compared with the pterional approach, and the present procedure is more suitable for the subtemporal approach.
authors.affiliation: Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan. skakino@iwate-med.ac.jp
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kakino
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kubo
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nishimoto
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography; D003399:Craniotomy; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000473:pathology / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D020769:Posterior Cerebral Artery / Q000473:pathology / Q000601:surgery*; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013525:Surgical Instruments; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation