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Figure 11: During the actual surgery, (a) A left fronto-temporal craniotomy is performed. (b) The retraction of the frontal lobe reveals the optic nerve (II) and the left internal carotid artery (ICA). The surface of the internal carotid artery is irregular and reddish and thin- walled due to the arterial dissection and the fusiform aneurysmal dilatation (*) present. (c) The complete exposure of the internal carotid artery (ICA), its bifurcation and anterior cerebral artery (ACA) reveal a dissecting fusiform aneurysm (*) arising from the internal carotid artery (ICA). II: Optic nerve. (d) A clip is applied across the broad neck of the fusiform aneurysm. The proximal internal artery (prox. ICA) still appeared reddish, thin walled and abnormal. Distal ICA: The part of ICA distal to the dissecting aneurysm; II: Optic nerve; ACA: Anterior cerebral artery. (e) The lumen of the clipped aneurysm is aspirated to ensure that there is no residual filling. Prox. ICA: Proximal internal artery; Distal ICA: The part of ICA distal to the dissecting aneurysm; II: Optic nerve; ACA: Anterior cerebral artery; (f) The abnormally looking proximal (Prox. ICA) and distal internal carotid artery (Distal ICA) are wrapped with muscle and surgicel, and fibrin glue is applied over them, in order to reinforce this part of the arterial wall. Prox. ICA: Proximal internal artery; Distal ICA: The part of ICA distal to the dissecting aneurysm; II: Optic nerve; ACA: Anterior cerebral artery

Figure 11: During the actual surgery, (a) A left fronto-temporal craniotomy is performed. (b) The retraction of the frontal lobe reveals the optic nerve (II) and the left internal carotid artery (ICA). The surface of the internal carotid artery is irregular and reddish and thin- walled due to the arterial dissection and the fusiform aneurysmal dilatation (*) present. (c) The complete exposure of the internal carotid artery (ICA), its bifurcation and anterior cerebral artery (ACA) reveal a dissecting fusiform aneurysm (*) arising from the internal carotid artery (ICA). II: Optic nerve. (d) A clip is applied across the broad neck of the fusiform aneurysm. The proximal internal artery (prox. ICA) still appeared reddish, thin walled and abnormal. Distal ICA: The part of ICA distal to the dissecting aneurysm; II: Optic nerve; ACA: Anterior cerebral artery. (e) The lumen of the clipped aneurysm is aspirated to ensure that there is no residual filling. Prox. ICA: Proximal internal artery; Distal ICA: The part of ICA distal to the dissecting aneurysm; II: Optic nerve; ACA: Anterior cerebral artery; (f) The abnormally looking proximal (Prox. ICA) and distal internal carotid artery (Distal ICA) are wrapped with muscle and surgicel, and fibrin glue is applied over them, in order to reinforce this part of the arterial wall. Prox. ICA: Proximal internal artery; Distal ICA: The part of ICA distal to the dissecting aneurysm; II: Optic nerve; ACA: Anterior cerebral artery