Since 1986 Friedman et al. employed a transpetrosal approach for access to selective basilar artery aneurysms. Removal of the petrous apex provided an expanded deep window through which infraclinoidal basilar artery aneurysms can be controlled 1).
Extradural subtemporal access to the petrosal ridge and a resection of the anterior pyramidal bone produced direct observation of the lower basilar artery, with minimum retraction of the temporal lobe and preservation of the temporal bridging veins. Two patients with lower basilar trunk aneurysms facing toward the brain stem, were operated on by the “transpetrosal approach,” with successful clipping of the aneurysms. Auditory function was preserved in one case. This approach decreases the possibility of retraction damage to the temporal lobe, brain stem, or cranial nerves, and may be helpful for surgery of aneurysms arising around the vertebrobasilar junction or at the origin of the anterior inferior cerebellar artery 2).