title: A modified anterior temporal approach for low-position aneurysms of the upper basilar complex.
abstract: BACKGROUND
  Although surgery for aneurysms of the upper basilar complex is generally accomplished by a pterional or subtemporal approach, both techniques have disadvantages. Therefore, attempts have been made to combine both the approaches, such as an anterior temporal approach, which exposes the anterior aspect of the temporal lobe during standard fronto-temporal craniotomy. However, in all these techniques, the temporal vein is sacrificed to allow posterior retraction of the temporal lobe, which may cause venous infarction in the temporal lobe.
  
  
  METHODS
  Our institutional review board approved this prospective study. We modified the anterior temporal approach for low-position aneurysms of the upper basilar complex by performing posterior clinoidectomy as necessary, thereby preventing the sacrifice of all vessels.
  
  
  RESULTS
  From 2007 to 2014, seven patients were operated on using this modified approach, and four patients underwent additional posterior clinoidectomy. Complete clip ligation was performed for all aneurysms without sacrificing any vessels, and there were no permanent complications attributable to manipulation for clipping or posterior clinoidectomy.
  
  
  CONCLUSIONS
  The modified anterior temporal approach allows a wider operating field within the retro-carotid space, without sacrificing any vessels, and permits safer posterior clinoidectomy and aneurysm clipping in patients with low-position aneurysms of the basilar complex.
authors: Department of Neurosurgery, Abashiri Neurosurgical and Rehabilitation Hospital, Abashiri, Japan.
authors: Makoto
authors: M
authors: Katsuno
authors: Department of Neurosurgery, Teishinkai Hospital, Sapporo, Hokkaido, Japan.
authors: Rokuya
authors: R
authors: Tanikawa
authors: Department of Neurosurgery, Abashiri Neurosurgical and Rehabilitation Hospital, Abashiri, Japan.
authors: Naoto
authors: N
authors: Izumi
authors: Department of Neurosurgery, Abashiri Neurosurgical and Rehabilitation Hospital, Abashiri, Japan.
authors: Masaaki
authors: M
authors: Hashimoto
keywords: Anterior temporal approach; basilar artery; posterior clinoidectomy; surgery
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