Abstract
Summary: Basilar bifurcation aneurysms (BA ANs) are currently being treated surgically by endovascular procedures in many institutions. However, aneurysm obliteration by clipping remains the most permanent cure for aneurysms. A subtemporal approach for BA AN has been established in many text books. The benefits of the subtemporal approach are short operative times and no need for skull base resection, while the disadvantages are oculomotor nerve palsy and temporal lobe injury due to excessive brain retraction. Here, we describe tips to help avoid temporal lobe damage, including body and head position, skin incision, craniotomy, and operative procedure performed under the microscope; an approach based on clinical experience. This report describes the usefulness of stepwise aspiration f cerebrospinal fluid from the crural cistern, the brain retraction technique using gelatin sponge to inimize intraoperative temporal lobe retraction, and fenestrated clip to obliterate BA AN.
