Zygomatic temporopolar approach for basilar artery aneurysms

For surgery of upper basilar artery aneurysms, we have modified the temporopolar approach proposed by Sano by detaching the zygomatic arch to obtain a wide, shallow operating field. This approach seems to be suitable for anteriorly protruding, high-positioned, or large aneurysms of the upper basilar artery. We have used this zygomatic temporopolar approach in 4 patients with such aneurysms and obtained satisfactory results. In this paper, we detail the operative procedure and emphasize certain technical points to minimize temporal lobe retraction and to prevent oculomotor and facial nerve injuries.