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Figure 8: Case 2: (a) The dura over the planum sphenoidale (#) covering the contralateral aneurysm (*C/L) is reflected to expose the underneath bone. C/L II: Right-sided optic nerve; II: Left-sided optic nerve; I/L ICA: Left-sided ICA; ACA: Anterior cerebral artery. (b) The contralateral (right-sided) planum sphenoidale (#) and anterior clinoid process are drilled, exposing the proximal portion of the right internal carotid artery (C/L ICA) and the proximal part of the neck of the contralateral aneurysm (*C/L). II C/L: Right-sided optic nerve; II: Left-sided optic nerve; ACA: Anterior cerebral artery. (c) After drilling the planum sphenoidale (#) and anterior clinoid process, a dissector is insinuated between the fundus of contralateral aneurysm (*C/L) and the reflected dura over the planum sphenoidale (#), to ensure the presence of an adequate space between these structures and the aneurysm for the insertion of the clip blade. The contralateral (right-sided) ICA from which the aneurysm is arising is also seen. II C/L: Right-sided optic nerve; II: Left-sided optic nerve; ACA: Anterior cerebral artery. (d) The first clip is applied to the neck of contralateral aneurysm. II: Left-sided optic nerve; ACA: Anterior cerebral artery. (e) The second clip is applied to the neck (arrow) of the contralateral aneurysm. The patent contralateral (right-sided) ICA and the optic nerve (C/L II) are also seen. #: Drilled planum sphenoidale. (f) After removal of the retractors, surgicel spread over the frontal and temporal lobes, is seen. Postoperatively, the patient remained in the same clinical status as that at admission. At a follow-up visit, there was no improvement of vision in the left eye visual acuity and there have been no further episodes of subarachnoid hemorrhage

Figure 8: Case 2: (a) The dura over the planum sphenoidale (#) covering the contralateral aneurysm (*C/L) is reflected to expose the underneath bone. C/L II: Right-sided optic nerve; II: Left-sided optic nerve; I/L ICA: Left-sided ICA; ACA: Anterior cerebral artery. (b) The contralateral (right-sided) planum sphenoidale (#) and anterior clinoid process are drilled, exposing the proximal portion of the right internal carotid artery (C/L ICA) and the proximal part of the neck of the contralateral aneurysm (*C/L). II C/L: Right-sided optic nerve; II: Left-sided optic nerve; ACA: Anterior cerebral artery. (c) After drilling the planum sphenoidale (#) and anterior clinoid process, a dissector is insinuated between the fundus of contralateral aneurysm (*C/L) and the reflected dura over the planum sphenoidale (#), to ensure the presence of an adequate space between these structures and the aneurysm for the insertion of the clip blade. The contralateral (right-sided) ICA from which the aneurysm is arising is also seen. II C/L: Right-sided optic nerve; II: Left-sided optic nerve; ACA: Anterior cerebral artery. (d) The first clip is applied to the neck of contralateral aneurysm. II: Left-sided optic nerve; ACA: Anterior cerebral artery. (e) The second clip is applied to the neck (arrow) of the contralateral aneurysm. The patent contralateral (right-sided) ICA and the optic nerve (C/L II) are also seen. #: Drilled planum sphenoidale. (f) After removal of the retractors, surgicel spread over the frontal and temporal lobes, is seen. Postoperatively, the patient remained in the same clinical status as that at admission. At a follow-up visit, there was no improvement of vision in the left eye visual acuity and there have been no further episodes of subarachnoid hemorrhage