Basilar artery and internal carotid paraclinoid aneurysms are still surgically challenging. We performed 31 clipping surgeries (basilar tip aneurysm 6, basilar artery-superior cerebellar artery aneurysm 8, and internal carotid aneurysm 17) via the extradural temporopolar approach. After the frontotemporal craniotomy, the meningo-orbital band was incised and the dura propria of the temporal lobe was peeled from the lateral wall of the cavernous sinus. The anterior clinoid process was removed extradurally. The distal dural ring and falciform ligament were incised for mobilization of the internal carotid artery and optic nerve. The temporal lobe was retracted posteriorly with the dura mater. The aneurysm clipping was performed through the relatively wide operative trajectory over the opened cavernous sinus. Postoperative outcome was modified Rankin Scale (mRS) 0 in 28 patients and mRS in three patients with visual deficits. No temporal lobe contusion occurred.
The extradural temporopolar approach is a useful skull base technique for deeply situated aneurysms.
