Frontobasal bridging vein rerouting for microsurgical clipping of a posterior cerebral artery aneurysm through anterior temporal approach: A technical note.

BACKGROUND

Posterior cerebral artery (PCA) aneurysms are extremely rare and challenging to treat because of their deep location and complex morphology. We describe a case of an enlarging thrombosed PCA aneurysm successfully treated with direct neck clipping through an anterior temporal approach (ATA) incorporating frontobasal bridging vein (FBBV) sacrifice and venous rerouting.

METHODS

A 48-year-old man was incidentally found to have a right PCA aneurysm during routine magnetic resonance imaging (MRI). Over an 8-year period, the aneurysm progressively enlarged and developed perifocal edema in the right cerebral peduncle, prompting surgical intervention. Direct neck clipping was performed using the ATA with FBBV sacrifice and venous rerouting through side-to-side anastomosis between sylvian veins to maintain venous drainage and secure adequate exposure.

RESULTS

Postoperative MRI demonstrated no infarction or venous congestion, and angiography confirmed complete aneurysm obliteration with preserved right PCA patency and a reconstructed venous drainage route. The patient was discharged with a modified Rankin Scale score of 0 and remained symptom-free at 3-year follow-up.

CONCLUSION

Direct neck clipping of a thrombosed PCA aneurysm through the ATA with FBBV sacrifice and venous rerouting was safe and effective. The sphenoparietal sinus transposition technique, combined with venous rerouting, provided optimal surgical exposure while minimizing the risk of complications.