The frontotemporal approach is the most commonly used for the surgery of aneurysms in the anterior part of the circle of Willis as well as for sellar and parasellar lesions. After the Sylvian fissure has been split and dissection carried out along the mediobasal temporal lobe, structures behind the level of the dorsum sellae can be attained. The subtemporal approach as described by Drake (1965) allows direct access from laterally to structures behind the dorsum sellae. For sufficient access to the clivus and the structures of the prepontine space the following modifications have been proposed: large-scale extradural resection of the lesser wing of the sphenoid bone in the pterional approach (Yaşargil 1976), or the frontotemporal approach involving partial resection of the temporal lobe (Schisano and Tovi 1962; Symon 1982; Sekhar and Moller 1986). The subtemporal approach (Drake 1965, 1973; Peerless and Drake 1982) was extended toward the posterior fossa by splitting the tentorium (Schisano and Tovi 1962, case 2; Bonnal et al. 1964; Krayenbühl and Yaşargil 1975). A further interesting modification of the frontotemporal approach without resection of the temporal lobe was developed by Samii (1986), in which wide access to the posterior fossa from a frontotemporal direction is gained when the apex of the petrous bone is drilled off between the trigeminal impression and the internal auditory canal. Sugita et al. (1978) uses this modification for aneurysms of the basilar trunk. Kawase et al. (1985) developed a similar modification by fenestration of the tentorium to clip basilar artery aneurysms. Subtemporal craniotomy and additional temporary splitting of the zygomatic arch has been presented as an approach to basilar aneurysms (Pitelli et al. 1986) or tumors (Sekhar and Moller 1986; Kawase et al. 1987). The combination of a subtemporal approach and lateral suboccipital craniotomy is another option which will be presented in Chap. 9.
KeywordsInternal Carotid Artery Cavernous Sinus Trigeminal Nerve Posterior Cerebral Artery Oculomotor Nerve
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