An Operative Case of the P3 Segment Aneurysm of the Posterior Cerebral Artery Treated with the Posterior Subtemporal Approach

We present a surgical case of distal posterior cerebral artery (PCA) aneurysms with the advantages of the posterior subtemporal approach. A 68-year-old woman had a ruptured left P3 segment aneurysm, unruptured left P2 segment and left middle cerebral artery (MCA) aneurysms. On the first day, the MCA aneurysm was clipped with irrigation and washout of dense subarachnoid clots in the left Sylvian fissure. On the fifth day, the left PCA aneurysms were clipped via the posterior subtemporal route. We could easily reach the ruptured aneurysm located in the quadrigeminal cistern along the tentorial surface via the wide space behind the vein of Labbe. After VP shunting, the woman was discharged with no neurological deficits. This approach to the distal PCA aneurysms provides early observation of the proximal trunk of the PCA, minimal retraction of the temporo-occipital lobe and safe manipulation of the vein of Labbê.