Clipping Posteriorly Directed Posterior Communicating Artery Aneurysms Using the Anterior Temporal Approach.

Abstract

To investigate the advantages and essential technical aspects of the anterior temporal approach (ATA) in clipping the posteriorly directed posterior communicating artery (PCOM) aneurysms. Anatomical dissections using the ATA were performed on 2 cadaveric heads (4 sides) to expose PCOM aneurysms. A total of 9 patients with PCOM aneurysms who underwent clipping using the ATA between January 2024 and June 2025 were retrospectively summarized and analyzed. This included 7 cases with posteromedial inferior-directed, one with posterolateral inferior-directed, and one with posterolateral superior-directed PCOM aneurysms. The ATA provides significant advantages in exposing posteriorly directed PCOM aneurysms compared to the pterional trans-Sylvian, lateral supraorbital, and subtemporal approaches. Moreover, it allows a "Looking in" and "Looking up" exposure and operative view. In all 9 patients included in this study, the anatomical relationships among the internal carotid artery, PCOM, and the aneurysm were clearly demonstrated during clipping using the ATA. All patients recovered well postoperatively without any new neurological deficits. The ATA effectively exposes and clips posteriorly directed PCOM aneurysms compared with other conventional approaches. It is a safe and reproducible surgical technique worth promoting and disseminating.