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Basilar Aneurysm: Subtemporal Approach

Last Updated: April 25, 2020

An in-depth understanding of the anatomy of the interpeduncular fossa from the subtemporal corridor is necessary for clip ligation of the basilar bifurcation aneurysms through this route.

Although the transsylvian approach with its half-and-half modifications can reach most basilar bifurcation aneurysms, some low-lying aneurysms will not be amenable to this approach. This is particularly true if the aneurysm neck resides up to 5 to 10 mm below the dorsum sella as seen on a sagittal view of the computed tomography (CT) angiogram.

In addition, I do not favor the pterional route for posterior-projecting aneurysms because the vital thalamoperforators are buried behind the aneurysm and often not easily viewable through the subfrontal operative trajectory.

The subtemporal approach addresses both of these anatomic constraints. Unfortunately, the temporal lobe must be substantially...