Objective: We discuss a detailed surgical technique, its indications, and potential pitfalls in its use.
Methods: A surgical procedure combining Kawase's anterior petrosectomy and external carotid artery-to-posterior cerebral artery high-flow bypass was performed for the treatment of a patient with a fusiform basilar trunk aneurysm.
Results: Follow-up angiography revealed the successful obliteration of the aneurysm and that the graft was functioning well. Late ischemic complications, however, occurred 5 weeks after surgery.
Conclusion: Kawase's approach is a versatile option for safe vascular reconstruction of the posterior cerebral artery and exposure of a basilar trunk aneurysm in the upper clival region. Although, theoretically, a high-flow bypass might decrease the risk of hemodynamic ischemia, it does not prevent thromboembolic complications.