In basilar bifurcation aneurysm surgery, it is most important to get a wide operative field. The transsylvian approach or subtemporal approach have been performed for basilar bifurcation aneurysms. In the transsylvian approach, perforators from the posterior communicating artery and the internal carotid artery restrict access to the basilar bifurcation aneurysm. The subtemporal approach has the risk of venous damages or contusion of the temporal lobe. We have the anterior temporal approach for basilar bifurcation aneurysms. The anterior temporal approach is a modified distal transsylvian approach and the operators can keep a wide operative field. Superficial sylvian veins are dissected from the temporal lobe and moved to the frontal lobe, and the anterior temporal artery is separated from the medial surface of the temporal lobe completely. Dissection of vessels from the temporal lobe enables retraction of the temporal lobe posteriorly with minimum power. We describe some key operative techniques and some advantages and problems of the anterior temporal approach.
