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Figure 5: Case 1: (a) A dissector is insinuated along the proximal aspect of neck of the aneurysm (*). The drilling of the planum sphenoidale (#) over the optic nerve (II) helps to gently mobilize the latter in order to access the proximal part of neck of the aneurysm. (b) The clip is applied over the neck of aneurysm (*) while ensuring that the lumen of internal carotid artery (ICA) is patent. The posterior communicating artery (P Comm A) and cavernous sinus (CS) are also seen. II: Optic nerve; CS: Cavernous sinus. (c) A second clip is placed over the neck of aneurysm (*) just proximal to the previous clip. #: Planum sphenoidale; II: Optic nerve; ICA: Internal carotid artery; CS: Cavernous sinus; P Comm A: Posterior communicating artery; III: Subarachnoid part of the oculomotor nerve entering the cavernous sinus (CS). (d) The fundus of the aneurysm (*) is opened using microscissors to remove the clot (arrow). The deflation of the fundus of the aneurysm relieves pressure over the optic nerve (II) and chiasma. ICA: Internal carotid artery; CS: Cavernous sinus. (e) The relaxed frontal and temporal lobes are seen after surgery. (f) The postoperative angiogram showing the patent internal carotid artery (ICA), ophthalmic artery and two clips applied to secure the aneurysm. The patient made an uneventful recovery with complete resolution of the bitemporal field defect

Figure 5: Case 1: (a) A dissector is insinuated along the proximal aspect of neck of the aneurysm (*). The drilling of the planum sphenoidale (#) over the optic nerve (II) helps to gently mobilize the latter in order to access the proximal part of neck of the aneurysm. (b) The clip is applied over the neck of aneurysm (*) while ensuring that the lumen of internal carotid artery (ICA) is patent. The posterior communicating artery (P Comm A) and cavernous sinus (CS) are also seen. II: Optic nerve; CS: Cavernous sinus. (c) A second clip is placed over the neck of aneurysm (*) just proximal to the previous clip. #: Planum sphenoidale; II: Optic nerve; ICA: Internal carotid artery; CS: Cavernous sinus; P Comm A: Posterior communicating artery; III: Subarachnoid part of the oculomotor nerve entering the cavernous sinus (CS). (d) The fundus of the aneurysm (*) is opened using microscissors to remove the clot (arrow). The deflation of the fundus of the aneurysm relieves pressure over the optic nerve (II) and chiasma. ICA: Internal carotid artery; CS: Cavernous sinus. (e) The relaxed frontal and temporal lobes are seen after surgery. (f) The postoperative angiogram showing the patent internal carotid artery (ICA), ophthalmic artery and two clips applied to secure the aneurysm. The patient made an uneventful recovery with complete resolution of the bitemporal field defect