Superolateral View of a Right Carotid Cave Aneurysm. A, Superolateral view of a right carotid cave aneurysm. The neck of the aneurysm is located in the cave below the distal dural ring just above the origin of the superior hypophyseal artery. The anterior clinoid process has been removed and the dura forming the lateral and anterior margins of the distal ring has been opened. B, The most common clip application for this type of aneurysm is an angled fenestrated clip advanced from distal to proximal across the aneurysm neck. The margin of the cave has been retracted to expose the aneurysm neck. The clip is being advanced toward the aneurysm neck. Care is required to avoid occluding the origins of the ophthalmic, superior hypophyseal, posterior communicating, anterior choroidal, and perforating arteries arising from the ICA. C, The clip has been closed and the aneurysm has been deflated. There is a shadow across the ICA at the level at which the ring surrounded the artery before the dissection. (Images courtesy of AL Rhoton, Jr.)