Operation for Aneurysms at the Highly Placed Basilar Bifurcation

Surgery for aneurysm at a highly placed bifurcation is one of the most difficult operations. The usual approaches for basilar bifurcation aneurysms are pterional and subtemporal. However, aneurysms located 1.5 cm higher than the posterior clinoid process are difficult to approach these methods. The transzygomatic subtemporal approach makes it easier to approach the aneurysms situated up to 2cms higher than the posterior clinoid process. The patient is placed in a semiprone position with the face turned 60° contralaterally. The skin incision is started just anterior to the external auditory meatus. The zygomatic arch is removed after reflecting the temporalis muscle. Part of the base of the middle cranial fossa is removed. After opening the dura the temporal lobe is retracted upwards. The tentorial edge, PCA, fourth nerve, and third nerve are seen followed by the basilar artery and aneurysm. The aneurysm is prepared and clipped. The authors report three cases treated by this approach