• Felix Goehre, Hiroyasu Kamiyama, Kosumo Noda, Nakao Ota, Toshiyuki Tsuboi, Shiro Miyata, Takashi Matsumoto, Takeshi Yanagisawa, Sadahisa Tokuda, and Rokuya Tanikawa.
• Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan; Department of Neurosurgery, Stroke Center, Bergmannstrost Hospital Halle, Halle, Germany. Electronic address: fgoehre@gmail.com.
• World Neurosurg. 2016 Feb 1; 86: 490-6.

BackgroundPosterior cerebral artery (PCA) aneurysms are often fusiform and associated with multiple intracranial aneurysms. A bypass procedure in combination with proximal occlusion or aneurysm trapping is considered to be effective for the treatment of patients with complex PCA aneurysms. Because of the deep, narrowed surgical corridor and the surrounding sensitive neuroanatomic structures, microsurgical procedures applied to the PCA are technically demanding. The authors present a technical report of a complex aneurysm formation located at the postcommunicating segment of the PCA (PCA-P2) treated via an anterior temporal approach.MethodsA 68-year-old woman had an unruptured PCA-P2 aneurysm formation, which was discovered incidentally. The fusiform aneurysm shape of the distal aneurysm aggravated direct microsurgical and endovascular treatment. After an individual case discussion, the patient underwent a microsurgical clipping of the proximal P2 segment aneurysm and the distal PCA-P2 segment aneurysm was treated by trapping after the application of a superficial temporal artery (STA) to PCA-P2 bypass using an anterior temporal approach.ResultsPostoperative computed tomography angiography showed the exclusion of the proximal PCA-P2 aneurysm and an adequate flow from the STA to PCA-P2 bypass to the distal PCA segments. The patient showed a modified Rankin scale of 0 after follow-up at 1 and 3 months.ConclusionsThe anterior temporal approach is feasible for the microsurgical management of complex postcommunicating PCA aneurysms and the application of bypass procedures.Copyright © 2016 Elsevier Inc. All rights reserved.

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