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Figure 7: Case 2: (a) A left fronto-temporal craniotomy with a wide Sylvian fissure opening are performed. (b) The medially directed, left-sided superior hypophyseal artery aneurysm (*), arising from the left internal carotid artery (ICA), is seen. The optic nerve (II) is stretched over the fundus of the aneurysm. (c) The dura over the planum sphenoidale (#) is incised and reflected downwards. The planum sphenoidale (#) is drilled using a diamond drill. (d) The proximal 8-millimetres of the optic nerve (II) and the clinoidal segment of the left internal carotid artery (ICA) are exposed. A large aneurysm with a wide neck, with its fundus extending on both sides of the left internal carotid artery is seen (*I/L). The fundus of contralateral (right-sided) aneurysm is directed medially, closely approximated to the left sided aneurysm (*C/L) [arrow]. The planum sphenoidale (#) over the contralateral aneurysm is also seen. The posterior communicating (PComm) artery exits from the left ICA just distal to the left ICA aneurysm. The dorsum sellae (DS) is seen lateral to the left internal carotid artery. Space is created between the fundus of left internal carotid artery aneurysm (*I/L) and the optic nerve (II; after its mobilization by drilling the planum sphenoidale over the optic foramen). (e) Proximal control was taken in the neck and distal control in the ICA just proximal to the posterior communicating artery. Three fenestrated straight clips are applied in tandem, preserving the lumen of supraclinoid segment of the left internal carotid artery (ICA) proximally, while securing the neck of the aneurysm (*I/L). The distal-most clip is proximal to the origin of posterior communicating artery from the ICA. The contralateral aneurysm (*C/L) is also seen. #: Planum sphenoidale over contralateral (right-sided) aneurysm (f) The microscope is shifted to the side of the contralateral aneurysm (*C/L) whose neck is partly hidden behind the contralateral optic nerve (C/L II) and planum sphenoidale (#). II: Left-sided optic nerve; I/L ICA: Left-sided ICA

Figure 7: Case 2: (a) A left fronto-temporal craniotomy with a wide Sylvian fissure opening are performed. (b) The medially directed, left-sided superior hypophyseal artery aneurysm (*), arising from the left internal carotid artery (ICA), is seen. The optic nerve (II) is stretched over the fundus of the aneurysm. (c) The dura over the planum sphenoidale (#) is incised and reflected downwards. The planum sphenoidale (#) is drilled using a diamond drill. (d) The proximal 8-millimetres of the optic nerve (II) and the clinoidal segment of the left internal carotid artery (ICA) are exposed. A large aneurysm with a wide neck, with its fundus extending on both sides of the left internal carotid artery is seen (*I/L). The fundus of contralateral (right-sided) aneurysm is directed medially, closely approximated to the left sided aneurysm (*C/L) [arrow]. The planum sphenoidale (#) over the contralateral aneurysm is also seen. The posterior communicating (PComm) artery exits from the left ICA just distal to the left ICA aneurysm. The dorsum sellae (DS) is seen lateral to the left internal carotid artery. Space is created between the fundus of left internal carotid artery aneurysm (*I/L) and the optic nerve (II; after its mobilization by drilling the planum sphenoidale over the optic foramen). (e) Proximal control was taken in the neck and distal control in the ICA just proximal to the posterior communicating artery. Three fenestrated straight clips are applied in tandem, preserving the lumen of supraclinoid segment of the left internal carotid artery (ICA) proximally, while securing the neck of the aneurysm (*I/L). The distal-most clip is proximal to the origin of posterior communicating artery from the ICA. The contralateral aneurysm (*C/L) is also seen. #: Planum sphenoidale over contralateral (right-sided) aneurysm (f) The microscope is shifted to the side of the contralateral aneurysm (*C/L) whose neck is partly hidden behind the contralateral optic nerve (C/L II) and planum sphenoidale (#). II: Left-sided optic nerve; I/L ICA: Left-sided ICA