title: Subtemporal approach to posterior cerebral artery aneurysms.
abstract: OBJECTIVE
  Aneurysms of the posterior cerebral artery (PCA) are rare, and therefore the individual and institutional experience of their microsurgical management is usually limited. In the present article, we describe our experience with the subtemporal approach to aneurysms arising from the PCA.
  
  
  METHODS
  We reviewed 34 patients diagnosed with 37 PCA aneurysms, all microsurgically managed using the subtemporal approach between 1980 and 2012 at 2 Finnish neurosurgical centers (Helsinki and Kuopio). The following procedures were applied using the subtemporal approach: neck clipping (n = 24); proximal occlusion (n = 7); trapping (n = 2); wrapping (n = 1); aneurysmoraphy (n = 1); bypass bridging/trapping (n = 1); and a complex excimer laser-assisted nonocclusive anastomosis procedure (n = 1).
  
  
  RESULTS
  Of these 34 patients, 16 presented with acute subarachnoid hemorrhage as a result of PCA aneurysm rupture, and 11 of the 16 had good outcome (modified Rankin scale 0-2) at 3 months The remaining 18 patients were treated microsurgically for incidentally diagnosed unruptured aneurysms, and 14 of the 18 had a good outcome. The most common serious complication in this series was an ipsilateral PCA infarction (12/34; 35%), mostly after proximal occlusion (n = 7) and/or trapping (n = 2).
  
  
  CONCLUSIONS
  The subtemporal approach is a suitable approach to aneurysms of the segments P1, P1-P2 junction, and P2, as well as the anterior P3 segment of the PCA. Using the subtemporal approach, the cerebrospinal fluid is released before retraction is necessary to prevent temporal lobe injury. The subtemporal approach can provide enough space for revascularization procedures. The most encountered complications were not related to the subtemporal approach but to the specific nature of PCA aneurysms.
authors: Department of Neurosurgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland; Department of Neurosurgery, Bergmannstrost Hospital Halle, Halle, Germany. Electronic address: felix.goehre@bergmannstrost.de.
authors: Felix
authors: F
authors: Goehre
authors: Department of Neurosurgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
authors: Martin
authors: M
authors: Lehecka
authors: Department of Neurosurgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
authors: Behnam Rezai
authors: BR
authors: Jahromi
authors: Department of Neurosurgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
authors: Hanna
authors: H
authors: Lehto
authors: Department of Neurosurgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
authors: Riku
authors: R
authors: Kivisaari
authors: Department of Neurosurgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
authors: Ferzat
authors: F
authors: Hijazy
authors: Department of Neurosurgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
authors: Lamia
authors: L
authors: Nayeb
authors: Department of Neurosurgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
authors: Tetsuaki
authors: T
authors: Sugimoto
authors: Department of Neurosurgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
authors: Masaki
authors: M
authors: Morishige
authors: Department of Neurosurgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
authors: Ahmed
authors: A
authors: Elsharkawy
authors: Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland.
authors: Mikael
authors: M
authors: von und zu Fraunberg
authors: Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland.
authors: Juha E
authors: JE
authors: Jääskeläinen
authors: Department of Neurosurgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
authors: Juha A
authors: JA
authors: Hernesniemi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery; D001164:Arteriovenous Fistula / Q000473:pathology / Q000601:surgery*; D002648:Child; D003399:Craniotomy / Q000379:methods; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D020769:Posterior Cerebral Artery / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D013702:Temporal Lobe / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aneurysm; Microsurgical technique; Posterior cerebral artery; Subtemporal approach