Surgical management of basilar apex aneurysms is considered among the most technically challenging procedures and high located basilar apex makes the procedure more challenging. Pterional trans-sylvian (with or without orbitozygomatic extension) and subtemporal are the most commonly used approaches, however, it is sometimes difficult or impossible to access a high-positioned aneurysm of basilar bifurcation without excessive retraction of brain and neurovascular structures. We are reporting a 65-year-old woman presented with chronic hydrocephalus secondary to a high-located basilar apex aneurysm surgically clipped through trans-frontal trans-ventricular trans-choroidal approach. We described anatomical details for selecting this approach and surgical steps during the procedure.
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