Reversed Posterolateral Subtemporal Approach for Basilar Terminal Aneurysms

We describe our modified subtemporal approach for basilar terminal aneurysms. We have modified the conventional subtemporal approach to diminish temporal lobe retraction and the risk of damage to the temporal lobe. The surgeon stands at the dorsocaudal side of the patient's head and the operative microscope is introduced posterolaterally to the patient's head. The posterior part of the temporal lobe is slightly retracted upward anterior to the vein of Labbé. The tentorium and arachnoid are cut, and the cerebrospinal fluid is aspirated as much as possible. Thus the brain becomes slack at the initial stage of the operation. The operative microscope is positioned parallel to the inclination of the tentorium or temporal base. The basilar terminal vasculatures can be examined upward from below with minimal temporal lobe retraction and the aneurysm is clipped. The perforating arteries arising from the terminal portion of the basilar artery are well recognized in this modified approach.