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Surgery of direct neck clipping of basilar tip aneurysms is one of the most challenging procedures in vascular neurosurgery, as these lesions are deeply situated in the interpeduncular region and maintain an intimate relationship with important anatomical structures. So aneurysms of this location are now frequently treated with endovascular technique. Microsurgical clipping occlusion technique still, however, maintains its solid position because of its completeness. We suggest the transsylvian approach for aneurysms of this location. There are several tactics to improve operative results. A wider surgical field can be obtained by dissecting the sylvian fissure from the distal segment. And anterior clinoidectomy and unroofing of the optic canal widen the space around the internal carotid artery and its cisternal cavity. Transection of the posterior communicating artery is needed in particular cases. The temporary clipping method and intensive hypotension are useful for dissecting perforating arteries and ensuring complete neck clipping.
