Only about 15% of intracranial aneurysms involve the posterior circulation and about 80% of distal basilar aneurysms have their origin at the level of or above the posterior clinoid process. Therefore, they are potentially approachable via the pterional or trans-sylvian route. This imply that most neurosurgeons will relatively rarely be required to perform this procedure. Especially basilar bifurcation aneurysms arising substantially below the level of the posterior clinoid process or projecting posteriorly could be successfully repaired via subtemporal approach. There are number of unique surgical problems that can be best attacked through a subtemporal approach, and for this reason it is important to have facility with its performance and a detailed understanding of its advantages and limitations. Surgical tactics and pitfalls of subtemporal approach will be described with a basis of experiences in Yonsei University and review of literatures.