The problems of the anterior temporal approach for P2A segment aneurysms

Abstract

  Although the trans‒sylvian and subtemporal approaches are used for P2A segment aneurysms, these approaches are associated with temporal lobe damage due to retraction. We have thus decided to use the anterior temporal approach, which enables the acquisition of a wide retrocarotid space with minimum temporal retraction. Here we investigated the problems associated with the anterior temporal approach for P2A segment aneurysms. Between 2012 and 2018, two patients underwent surgery using the anterior temporal approach at our institute. In both cases, the operative corridors were changed from lateral to frontal because of the reduced temporal lobe retraction. Moreover, the high position of the aneurysms required an additional lateral orbitectomy after the zygomatic anterior temporal approach. Although one patient developed a small temporal lobe contusion after the surgery, the aneurysms in both patients were completely obliterated without any additional neurological symptoms. The anterior temporal approach was primarily developed for midline disorders (such as upper basilar aneurysms) and has been useful for the acquisition of temporal lobe mobility with no vessel damage. In these two cases involving high‒position P2A segment aneurysms, the approach was feasible, but the surgical corridor had to be changed from lateral to frontal and an orbitectomy had to be used instead of a zygomatectomy.