A transcallosal interforniceal approach was used for treatment of a posteriorly projecting high basilar bifurcation aneurysm with a neck located 30 mm above the posterior clinoid process. The aneurysm was successfully clipped via the third ventricle with minimal neurological deficits. This approach appears to be appropriate for basilar bifurcation aneurysms located more than 20 mm above the posterior clinoid process when the fundus projects posteriorly, and permits direct visualization of the aneurysmal neck and vital perforators with minimal brain retraction.
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