Anterior subtemporal approach for posteriorly projecting posterior communicating artery aneurysms

We report our experience with the anterior subtemporal approach for the posterior communicating artery aneurysm protruding posteriorly. Between 2000 and 2005, seven patients with posterior communicating artery aneurysm were operated on through the anterior subtemporal approach. The approach provided a better view than the pterional approach. This approach seems to be suitable for posteriorly projecting posterior communicating artery aneurysms. The advantages of the anterior subtemporal approach are as follows: (1) It provides a short and a direct trajectory to the aneurysm. (2) Aneurysmal neck and surrounding structures can be easily identified and secured compared with the pterional approach. (3) A previously placed clip for a middle cerebral artery or internal carotid artery aneurysm through the pterional route does not interfere with the clipping surgery for regrown or de novo posterior communicating artery aneurysms.