後方交通動脈瘤に対する後方投射後交通動脈瘤のクリッピング：前側頭アプローチ

To investigate the advantages and essential technical aspects of the anterior temporal approach (ATA) in clipping the posteriorly directed posterior communicating artery (PCOM) aneurysms.

Anatomical dissections using the ATA were performed on two cadaveric heads (four sides) to expose PCOM aneurysms. A total of nine patients with PCOM aneurysms who underwent clipping using the ATA between January 2024 and June 2025 were retrospectively summarized and analyzed. This included seven cases with posteromedial inferior-directed, one with posterolateral inferior-directed, and one with posterolateral superior-directed PCOM aneurysms.

The ATA provides significant advantages in exposing posteriorly directed PCOM aneurysms compared to the pterional trans-Sylvian, lateral supraorbital, and subtemporal approaches. Moreover, it allows a "Looking in" and "Looking up" exposure and operative view. In all nine patients included in this study, the anatomical relationships among the internal carotid artery, PCOM, and the aneurysm were clearly demonstrated during clipping using the ATA. All patients recovered well postoperatively without any new neurological deficits.

The ATA effectively exposes and clips posteriorly directed PCOM aneurysms compared with other conventional approaches. It is a safe and reproducible surgical technique worth promoting and disseminating.