title: Technical Description of the Medial and Lateral Anterior Temporal Approach for the Treatment of Complex Proximal Posterior Cerebral Artery Aneurysms.
abstract: BACKGROUND
  Posterior cerebral artery (PCA) aneurysms are often fusiform and associated with multiple intracranial aneurysms. A bypass procedure in combination with proximal occlusion or aneurysm trapping is considered to be effective for the treatment of patients with complex PCA aneurysms. Because of the deep, narrowed surgical corridor and the surrounding sensitive neuroanatomic structures, microsurgical procedures applied to the PCA are technically demanding. The authors present a technical report of a complex aneurysm formation located at the postcommunicating segment of the PCA (PCA-P2) treated via an anterior temporal approach.
  
  
  METHODS
  A 68-year-old woman had an unruptured PCA-P2 aneurysm formation, which was discovered incidentally. The fusiform aneurysm shape of the distal aneurysm aggravated direct microsurgical and endovascular treatment. After an individual case discussion, the patient underwent a microsurgical clipping of the proximal P2 segment aneurysm and the distal PCA-P2 segment aneurysm was treated by trapping after the application of a superficial temporal artery (STA) to PCA-P2 bypass using an anterior temporal approach.
  
  
  RESULTS
  Postoperative computed tomography angiography showed the exclusion of the proximal PCA-P2 aneurysm and an adequate flow from the STA to PCA-P2 bypass to the distal PCA segments. The patient showed a modified Rankin scale of 0 after follow-up at 1 and 3 months.
  
  
  CONCLUSIONS
  The anterior temporal approach is feasible for the microsurgical management of complex postcommunicating PCA aneurysms and the application of bypass procedures.
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan; Department of Neurosurgery, Stroke Center, Bergmannstrost Hospital Halle, Halle, Germany. Electronic address: fgoehre@gmail.com.
authors.forename: Felix
authors.initials: F
authors.lastname: Goehre
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kamiyama
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Kosumo
authors.initials: K
authors.lastname: Noda
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Nakao
authors.initials: N
authors.lastname: Ota
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Tsuboi
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyata
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yanagisawa
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Sadahisa
authors.initials: S
authors.lastname: Tokuda
authors.affiliation: Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan.
authors.forename: Rokuya
authors.initials: R
authors.lastname: Tanikawa
mesh_terms: D000368:Aged; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D020769:Posterior Cerebral Artery
keywords: Aneurysm; Anterior temporal approach; Bypass; Microsurgical technique; PCA; Posterior cerebral artery