Zygomatic Anterior Temporal Approach for High-position Upper Basilar Aneurysm.

Skull base techniques have often required high-position upper basilar aneurysm surgery based on a surgical corridor. Examples are the orbitozygomatic osteotomy for the trans-sylvian approach and zygomatic osteotomy for the subtemporal approach. However, clarity remains to be archived for the additional technique of the anterior temporal approach, including the middle surgical corridor of the trans-sylvian approach and subtemporal approach. In the present study, we describe the methodology and the problems associated with the zygomatic anterior temporal approach for high-position upper basilar artery aneurysms. Between 2007 and 2018, a total of 14 consecutive patients were received the same procedures of the zygomatic anterior temporal approach for high-position upper basilar aneurysms. Additionally, four patients underwent additional techniques to acquire further wide retro-carotid space. Complete ligation of all aneurysms was archived through the wide retro-carotid space in the absence of major surgical complications. Using the zygomatic anterior temporal approach, it is possible to both acquire a wide retro-carotid space and perform safety clip ligation of high-position upper basilar aneurysms without orbiotomy. However, additional orbiotomy should be taken into consideration by the surgeons if the orbital rim or internal carotid artery interferes with the surgical instruments or procedures.