The options of interventional coil placement and open clipping were discussed with the patient, and the patient elected surgical clipping. A lumbar drain was placed to reduce CSF pressure. Pins were placed in the scalp to monitor somatosensory evoked potential for signs of ischemia, and EEG leads were placed to monitor burst suppression from the barbiturates used to protect the brain in order to maintain a proper level. The patient's head was positioned in 3 point (one anterior, two posterior) Mayfield fixation at 60lb pressure. The face is to the upper right. Local anesthesia with epinephrine was infiltrated along the line of the incision.
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