• Juha Hernesniemi, Keisuke Ishii, Ayse Karatas, Leena Kivipelto, Mika Niemelä, Laszlo Nagy, and Hu Shen.
• Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland. juha.hernesniemi@hus.fi
• Neurosurgery. 2005 Oct 1; 57 (4 Suppl): E408; discussion E408.

ObjectiveTo describe a surgical technique to retract the tentorial edge during the subtemporal approach initially introduced and used widely by Drake and Peerless to treat distal basilar artery aneurysms.MethodsOne of the most important parts of the exposure is to reflect the edge of the tentorium downward by 1 cm or more and to tether it with a suture placed lateral to or behind the insertion of the trochlear nerve and then to the dura mater of the floor of the middle fossa. Surgical forceps or a sharp dural hook are used to elevate the tentorial edge, in front of the trochlear nerve. A small incision is made on the surface of the floor of the middle fossa using a sharp bipolar forceps, and a small straight microclip is inserted with one arm through the incision on the surface of the floor of the middle fossa and the other at the free margin of the tentorial edge.ResultsThe method described has been used by the senior author in more than 100 operations as a simple and fast means of tethering the free margin of the tentorial edge simply and quickly.ConclusionWe inserted a small straight microclip with one arm through the incision on the surface of the floor of the middle fossa and the other at the free margin of the tentorial edge as a fast and simple method of retracting the tentorial edge during a subtemporal approach.

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