We applied our zygomatic approach and its subtemporal modification in three patients with unusual aneurysms arising at the P1-P3 segment of the posterior cerebral artery.
The first patient had a ruptured aneurysm of the Pi segment, which involved the perforating vessels to the midbrain. Successful application of the clip was achieved, sparing the perforating vessels and forming a neck clippable by bipolar electrical coagulation. In this patient, the zygomatic approach with partial removal of the orbital rim provided excellent exposure of the P1 segment of the posterior cerebral artery.
The second patient had a ruptured fusiform aneurysm of the P2 segment, in which the zygomatic approach allowed an exposure wide enough to reinforce by wrapping and clipping.
In the third patient with a ruptured giant aneurysm of the P3 segment, a successful clipping with minimal elevation of the temporal lobe was achieved.
In all patients, the zygomatic approach and its subtemporal modification provided an exposure wide enough to permit safe manipulation.
