Abstract
Direct neck clipping of basilar top aneurysm is still difficult because this aneurysm is so deeply located that the operative field is narrow and restricted by many surrounds of important perforators and nerves. Moreover, because the transsylvian approach for these lesions is chosen, the internal carotid artery and the posterior communicating artery often restrict the access to the basilar top aneurysm. In surgery for basilar top aneurysm accompanied with ipsilateral internal carotid aneurysm, the transsylvian approach has the advantage that both aneurysms are clipped under the same operative field, though clipping for both aneurysms is more difficult and challenging than basilar tip aneurysm alone.
We describe several methods to obtain a wider approach for successful clipping of both aneurysms located internal carotid and basilar top.
