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Figure 3: Case 1: (a) A right-sided fronto-temporal craniotomy is performed. (b) The Sylvian fissure is opened by dissecting the arachnoid on the aspect of superficial middle cerebral vein towards the frontal lobe. (c) The opening of the arachnoid exposes the planum sphenoidale (#), optic nerve (2), internal carotid artery (ICA), and the subarachnoid part of the oculomotor nerve (III) entering the cavernous sinus (CS). CS: Cavernous sinus; P Comm A: Posterior communicating artery; *: Aneurysm. (d) Further retraction of the frontal lobe exposes the giant aneurysm (*). The aneurysm (*) has a wide neck arising from the internal carotid artery (ICA) and its fundus is directed towards the suprasellar region. The proximal aspect of its neck cannot be seen as it is hidden by the optic nerve (II). (e) The dura over the planum sphenoidale (#) and anterior clinoid is incised and reflected downwards. This maneuver protects the optic nerve from injury during drilling of the roof of optic foramen. The lateral wall of cavernous sinus (CS) is also seen. II: Optic nerve; ICA: Internal carotid artery. Reflecting the dura exposes the planum sphenoidale (#) over the optic foramen. Drilling this portion of the bone helps to expose and mobilize additional 6-8 millimeters of the optic nerve (II). ICA: Internal carotid artery; CS: Cavernous sinus; *: Aneurysm. This disconnects the anterior root of the anterior clinoid process (ACP). II: Optic nerve; ICA: Internal carotid artery; CS: Cavernous sinus. (f) The planum sphenoidale (#) has been drilled, exposing the falciform ligament (arrow) covering the distal 6-8 mm of the optic nerve within the optic foramen. The remnant of anterior clinoid process (ACP) is also seen. This represents the optic strut or the posterior root of the ACP, the small piece of bone separating the optic foramen from the superior orbital fissure. ICA: Internal carotid artery; CS: Cavernous sinus

Figure 3: Case 1: (a) A right-sided fronto-temporal craniotomy is performed. (b) The Sylvian fissure is opened by dissecting the arachnoid on the aspect of superficial middle cerebral vein towards the frontal lobe. (c) The opening of the arachnoid exposes the planum sphenoidale (#), optic nerve (2), internal carotid artery (ICA), and the subarachnoid part of the oculomotor nerve (III) entering the cavernous sinus (CS). CS: Cavernous sinus; P Comm A: Posterior communicating artery; *: Aneurysm. (d) Further retraction of the frontal lobe exposes the giant aneurysm (*). The aneurysm (*) has a wide neck arising from the internal carotid artery (ICA) and its fundus is directed towards the suprasellar region. The proximal aspect of its neck cannot be seen as it is hidden by the optic nerve (II). (e) The dura over the planum sphenoidale (#) and anterior clinoid is incised and reflected downwards. This maneuver protects the optic nerve from injury during drilling of the roof of optic foramen. The lateral wall of cavernous sinus (CS) is also seen. II: Optic nerve; ICA: Internal carotid artery. Reflecting the dura exposes the planum sphenoidale (#) over the optic foramen. Drilling this portion of the bone helps to expose and mobilize additional 6-8 millimeters of the optic nerve (II). ICA: Internal carotid artery; CS: Cavernous sinus; *: Aneurysm. This disconnects the anterior root of the anterior clinoid process (ACP). II: Optic nerve; ICA: Internal carotid artery; CS: Cavernous sinus. (f) The planum sphenoidale (#) has been drilled, exposing the falciform ligament (arrow) covering the distal 6-8 mm of the optic nerve within the optic foramen. The remnant of anterior clinoid process (ACP) is also seen. This represents the optic strut or the posterior root of the ACP, the small piece of bone separating the optic foramen from the superior orbital fissure. ICA: Internal carotid artery; CS: Cavernous sinus