 So, this anterior clean air process, so it is an extension of lateral wing of the spinoid bone. See, spinoid bone if you take into consideration it is having a body, the body which is covered by lesser wing of spinoid bone, laterally it is the greater wing of spinoid bone, anterior inferiorly is the teregoid plates that is the parts of the spinoid bone. So, when you take the lesser wing of the spinoid bone which goes posteriorly see this is the lesser wing of spinoid bone which goes posteriorly taking a curve and ends in the anterior clean air process tip. This is two process it is having. The length of the anterior clean air process is say 78 millimeters length it is not very big because under microscope it looks as if it is 1 inch, 2 inch like that. It is very very small anterior clean air process, so length is about 7 millimeters the thickness is about 4 mm, 4 to 5 mm and the lateral part of the spinoid bone that anterior clean air process is about 6 mm see the breadth see from ear to ear, this is the breadth, this is the anterior posterior diameter thickness is this. So, you have two openings, one is the optic canal, another one is optic strut in between these two is the optic canal which goes posterior that is in relation with the carotid artery. Sometimes middle clean air process also you should consider ok this is anterior clean air this is posterior clean air here is the one middle clean air process which comes. Sometimes there will be a ligament or sometimes it may be calcified to form a optic ring like thing it is not the dural ring it is the bony ring which will forms ok. So, during that time mobilization and all it will be difficult, so when you are doing the anterior clean airctamine say after the anterior clean airctamine you will get the ridge you have to nibble up to orbit of meningeal artery that is entering into the orbit. So, what you said there is no perforate what is the foramen no vagus no nerves and all it is in the roof of the orbit only on the medial aspect that alfactory nerves which is coming and joining into the alfactory bulb specially lateral to the crystalline where the alfactory bulb which is lying there. So, you reflect the dural superiorly see these are all attached by dural just on the upper part of the lesser wing of the spinoid bone just you retry separate the dural from the bone ok till you see the optic nerve optic nerve at that point dural is very very thin. So, once you elevating the things you will see the optic nerve itself that is the limiting point of the medial extent then you come to the lower part that is inferior to the lesser wing of the spinoid bone is the superior orbital ridge where the dural which is attached they are also you strip it downwards. So, that you will get a complete view of the anterior clean air process if you are not seeing that just put an incision along the lateral border of the anterior clean air process then you can separate superiorly and also inferiorly you will be seeing whole length then where to start bridging it. So, if you go very close the superior orbital fissure in that outer ring what are the structures which goes LFT lacrimal frontal proclure this is the way that this is the arranged ok. So, if you go very close you will be injuring this nerves what is that lacrimal or a frontal or a trochlear and also because cavernous area which is attached there there may be lot of bleeding which is there. So, once you close to the anterior clean air process that lateral part the posterior inferior part of the anterior clean air process is very close to the third nerve that is the one you have to remember not injuring the nerve when you are drilling it. So, now you have to perpendicularly you have to drill where do you start you are seeing the optic nerve because there is a very loose and dura that covers the optic canal that is the one what we call it as false quorum ligament. So, you through that you will be seeing the optic nerve in all the cases definitely there is no doubt in that. So, you need not worry optic nerve is there carotid artery is there if you once you start doing it we may injure this nothing will happen you have to see provided you have to see the when you are doing the angiogram you have to see steady the angiogram where is the fundus if the fundus in this area then you are in a problem because when you are drilling tend to in that tension you may injure the fundus that is the weakest point of the angiogram sac if it is neck is very close it will be thick wall only it will not rupture. So, boldly you can retract the dura and drill it. So, it shows the drilling part also so I told you the anatomy of the thing the fold contains many orbital artery and also vein just immediately a connective tissue separate the lacrimal nerve superior orbital vein. See another thing is you have to remember whether anterior clean up process pneumata is partially pneumata is or not why it is important see you have drill the anterior clean up process you do not know whether you have injured the mucosa that is the body of the spinot sinus which is covered by the mucosa whether you have injured it or not without your knowledge you might have injured you would have done surgery excellently I will show that example postoperatively patient may come with CSF rhinorrhea. Patient goes home nicely after that plurid meningitis and it may not be possible to treat the patient so your all procedure will be in wing so that is why you have to remember whether anterior clean up process is pneumatized or not when you drill it better whether it is pneumatized or not prophylactically plug that area with the bone mix always please remember that fine see some of the indications what he has said all the things it can be done that to when we are in the middle cranial force two layers of the dura that can be nicely it can be stripped off so that you can directly on the tumor and especially if it is panama you can complete surgery within no time by preserving all the nerves without injuring the arteries this is the what I was telling you the how to do cranial tyrannial craniotomy this is the protons already a revue monorhoi is told this is the picture see once you take the anterior clean up process see this is the area what we call it as para clean up area so where the carotid artery which is coming there it is a very narrow space superiorly you can see the ring distal ring this is the proximal ring once you take out the area the proximal part of the carotid artery will be nicely visible sometimes carotid or ophthalmic artery aneurysm you do not know where the ophthalmic artery takes origin whether it takes inter duraly or extra duraly sometimes it can take an origin from the extra duraly in the cavernous sinus itself okay then if the aneurysm which is arising from it will be very very difficult to clip those type of aneurysm if it is inter dural after clean aneurysm you will get the proximal part of the carotid artery let me to put the temporary clip otherwise it is impossible to put the clip why it is not possible see otherwise the diaphragm cell and all which is coming there itself there will be no space to go deeper when you go deep it will come in our way you cannot penetrate and go so you will be partially excluding the carotid artery thinking that you have completely excluded and once you put a needle there to decompress the aneurysm then it starts bleeding so you have to go for neck exposure then you should have a carotid control there so after all these things you will have a better space sometimes even that also you will not get when it is a giant aneurysm so the neck it will occupy so much you will not be knowing from where it is arising from the when you do angiogram and all it looks very nice when you start putting the clip it will not slip into the neck it will go and obliterate the part of the artery itself so those things are the problems of how to up to the neck of the aneurysm in that area so I will show you some of the videos see this is before taking out the anteroclinoid what I should this is the one after taking the clean air process so much of space is there sometimes the aneurysm the pulsation which is transmitting into the optic nerve you may not see the fibers of the optic nerve itself you may be seeing the only the arachnoid arachnoid over the optic nerve so patient will be completely blind where no question of reverting back of his vision sometimes when there is only just a stretch of the optic nerve there the chances of recovery of the vision is there but when it is inferiorly is the fundus of the aneurysm superiorly even part of the anterior cerebral artery so in between these the optic nerve comes so it will be actually it is strangulated between the two that is why vision will go away in those cases this is the case of multiple proximal carotid artery aneurysm this is by drilling the see I am separating this is the frontal surface this is the frontal surface temporal surface please you go all along the less serving of the spinoid bone till you see the optic nerve say so over that the false form ligament is there it is a false impression what we get it may be the bone it is not so bone so you have to cut when you want to mobilize the optic nerve so after this see see I have separated it see drilling that part see when we are not seen we can make an incision all along the then see why it is so tight because the ligaments which is attached to the tip of the anterior process that is the interclinoid ligament which is attached so to pulling that sometimes there may be bleeding from the cavernous anus that can be easily controlled see after that see I am separating the nerve from the artery there that is the nerve this is the proximal part of the carotid artery see there are so much of veins which are on the aneurysm see this is the distal part of the carotid artery this is the proximal part after taking out the anteroclineate process so much of space which is available that is clip then there was another aneurysm just I retracted I could see the aneurysm so I clipped on the opposite side also is the same craniotene see the aneurysm this is also joint aneurysm this is both intra and extradural nibbling of the anteroclineate process see that is the false form ligament being cut then after that along the anteroclineate process medial surface that is exposed so part of the bone is nibbled after cutting the false form ligament initially there was no aneurysm seen at all see the optic nerve there is no aneurysm but you can see the aneurysm on the lateral ear ear neck is not seen at all okay so after drilling this see now carotid artery seen this small bleeding will be there that will be start by surgery cell or a gel form see there is a calcified plague on the aneurysm itself now thinking that it is the neck so I have put a temporary clip there see once I put the clip just I open the fundage it is partially occluded so that is why there is a spurt see continuously it is putting there again I put a temporary clip at the there itself tentative clip that is okay now I have retracted the optic nerve after dissecting all the area see that is the neck see once the plague is there it is difficult to put the clip it slips see I have put the bigger one again I will put some more clips to occlude the neck and also to prevent the dislodgement of the clip see after putting this you see then I excite the sack after this see this is following surgery this is the one this anteroclinate process was pneumatized there initially I thought I wanted to pluck that area but after clipping by that time tired just it is closed after one month patient came with a meningitis fluorid meningitis and patient died see whatever we do little negligence you finally what is the result of it see everything it has come source nicely and all big venerism you can see that least after tinnotectomy see you will have a more space this is also a false form ligament that is the cut see this is to get the proximal control so that is the proximal control then this is the distal part of the neck see the where is the arising itself the whole artery itself is having a neck see this is part of the neck is completely is widened see after putting that say no that video it is not there see when I put this one then I will take out the proximal control when I took it it just opened the pressure is so much so it will net it will never occlude that part so that is why so many clips I have put that one see that is the poster communicating artery that is the anti-correlal branches see after that ICG which is showing patent keratid artery