Subtemporal approach for posterior communicating artery aneurysms

The management of true PCoA aneurysms and PCoA aneurysms projecting posteriorly is more complicated and challenging, and treating these lesions entails considerable risks via the pterional approach. Considering the above problems, we attempted to treat these refractory PCoA aneurysms through the subtemporal approach. Our results suggested that microsurgical clipping of these aneurysms via the subtemporal approach can achieve good clinical outcomes with a high preservation rate of the related branches. Appropriate patient selection, fully grasp of indications, precise understanding of the anatomy and thorough preoperative planning are crucial for successful surgery. The subtemporal approach appears to be a relatively safe and effective procedure in the experienced hands, and may be an alternative method for patients with true PCoA aneurysms or projecting posteriorly PCoA aneurysms which cannot be easily clipped from the pterional approach. It can provide a better lateral view to visualize the neck of the aneurysm, PCoA and its perforating vessels, as well as the other structures.