Subtemporal approach for a P2-P3 junction aneurysm of the posterior cerebral artery.

Aneurysms are seen rarely at the P2-P3 junction of the posterior cerebral artery (PCA). P2-P3 junction aneurysm surgery is challenging. Here, a successful clipping of a large P2-P3 junction aneurysm via a subtemporal approach is reported. A 26-year-old woman presented with a 6-month history of left occipito-parietal headache. Computed tomography (CT) scan, magnetic resonance imaging (MRI) and cerebral angiography revealed a 2-cm aneurysm at the P2-P3 junction of the left PCA. Successful neck clipping of the aneurysm was performed via a subtemporal approach without additional neurological deficits or surgical complications. Coil embolization has been suggested as the treatment of choice but PCA aneurysms are also good candidates for microsurgical clipping. The subtemporal approach is simple and safe in experienced hands. P2-P3 junction PCA aneurysms can be successfully clipped via the subtemporal approach without excessive brain retraction, resection of brain tissue or disruption of surface veins.