A 68-year-old woman had an unruptured PCA-P2 aneurysm formation, which was discovered incidentally. The fusiform aneurysm shape of the distal aneurysm aggravated direct microsurgical and endovascular treatment. After an individual case discussion, the patient underwent a microsurgical clipping of the proximal P2 segment aneurysm and the distal PCA-P2 segment aneurysm was treated by trapping after the application of a superficial temporal artery (STA) to PCA-P2 bypass using an anterior temporal approach.
Postoperative computed tomography angiography showed the exclusion of the proximal PCA-P2 aneurysm and an adequate flow from the STA to PCA-P2 bypass to the distal PCA segments. The patient showed a modified Rankin scale of 0 after follow-up at 1 and 3 months.
The anterior temporal approach is feasible for the microsurgical management of complex postcommunicating PCA aneurysms and the application of bypass procedures.