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Background: Critically ill children are vulnerable to acute kidney injury (AKI) and are often exposed to nephrotoxic medications. Objectives: We aimed to investigate the association between nephrotoxic medications and the risk of AKI in critically ill children admitted to our paediatric intensive care unit (PICU). Methods: Patients aged > 1 month to ≤18 years old were prospectively recruited from 6/2020 to 6/2021. The medication records from 14 days prior to PICU admission to PICU discharge were reviewed. Medication-exposure intensity was defined as the number of concomitant nephrotoxic medications. The relative risk (RR) of nephrotoxic medication exposure indices and other potential predictors for AKI development were determined. Results: Altogether 253 episodes of admissions (median [IQR] age of 4.9 [9.6] years) were enrolled. The AKI incidence was 41.9% and 69.2% of the patients were exposed to ≥1 of the 47 nephrotoxic medications. The total nephrotoxic medication dose (RR: 1.01 [1.00, 1.02]) and medication-exposure intensity (RR: 1.381 [1.101, 1.732]) were significantly associated with AKI development. The risk of AKI increased when the medication-exposure intensity was ≥4 (RR: 3.687 (1.320, 10.301)). During their PICU stay, children with AKI received a higher number (P < .01), total dose (P < .01) and medication exposure intensity (P < .01) of nephrotoxic medications. Children with AKI who received nephrotoxic medications were more likely to have a persistently higher peak-to-baseline ratio (P = .046). Conclusion: Nephrotoxic medication exposure significantly increased the risk of AKI development among critically ill children. The use of nephrotoxic medications among critically ill children at risk for AKI should be monitored frequently.
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This research examines how anchoring bias affects managers' multi-dimensional evaluations of supplier performance, supplier selection, and the effectiveness of two debiasing techniques. We consider the supplier past performance in one performance dimension as the anchor and investigate whether and how this anchor would have a knock-on effects on evaluating a supplier's performance in other dimensions. We conducted two online experimental studies (Study 1, sample size = 104 and Study 2, sample size = 408). Study 1 adopts a 2 x 1 (high anchor vs. low anchor) between-subjects factorial experimental design, and Study 2 is a 3 (debiasing: no, consider-the-opposite, mental-mapping) x 2 (high anchor vs. low anchor) between-subjects factorial design. The results from Studies 1 and 2 suggest that when a supplier has received a low evaluation score in one dimension in the past, participants assign the same supplier lower scores in the other dimensions compared to a supplier that has obtained a high score in the past. We also find that anchoring has a knock-on effect on how likely participants are to choose the same supplier in the future. Our findings highlight the asymmetric effectiveness of 'consider-the-opposite' and 'mental-mapping' debiasing techniques. This research is the first study that examines how anchoring bias managers' evaluations in a multi-dimensional setting and its knock-on effects. It also explores the effectiveness of two low-cost debiasing techniques. A crucial practical implication is that suppliers' exceptionally good or disappointing past performance affects the judgement of supply managers. Hence, managers should use consider-the-opposite or mental-mapping techniques to debias the effect of high and low anchors, respectively.
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A sufficient number of participants should be included to adequately address the research interest in the surveys with sensitive questions. In this paper, sample size formulas/iterative algorithms are developed from the perspective of controlling the confidence interval width of the prevalence of a sensitive attribute under four non-randomized response models: the crosswise model, parallel model, Poisson item count technique model and negative binomial item count technique model. In contrast to the conventional approach for sample size determination, our sample size formulas/algorithms explicitly incorporate an assurance probability of controlling the width of a confidence interval within the pre-specified range. The performance of the proposed methods is evaluated with respect to the empirical coverage probability, empirical assurance probability and confidence width. Simulation results show that all formulas/algorithms are effective and hence are recommended for practical applications. A real example is used to illustrate the proposed methods.
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Cystic craniopharyngiomas of the third ventricle can be challenging to treat because complete resection of the cyst wall can be associated with hypothalamic dysfunction and minimal rostral displacement of the optic chiasm leads to a small endonasal operative corridor. Various methods to overcome the frequent recurrences have been described, such as intracystic bleomycin or catheter placement, with mixed results.1-12 In Video 1, we describe a simple cystocisternal fenestration technique with preservation of the rostral cyst wall via an endoscopic endonasal approach where the solid portion of the tumor is resected, and the inferior wall of the cyst is opened into the prepontine cistern and the superior wall of the cyst and adjacent third ventricle are preserved. This allows for ventricular pressure to collapse the cyst cavity in the postoperative period. In select patients where safe complete resection of a cystic craniopharyngioma is prohibitive, this may provide a durable treatment and can be performed through a small endonasal corridor below a nondisplaced optic chiasm.
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Craneofaringioma , Neuroendoscopía , Neoplasias Hipofisarias , Tercer Ventrículo , Humanos , Craneofaringioma/cirugía , Craneofaringioma/diagnóstico por imagen , Neoplasias Hipofisarias/cirugía , Neoplasias Hipofisarias/diagnóstico por imagen , Tercer Ventrículo/cirugía , Neuroendoscopía/métodos , Neoplasias del Ventrículo Cerebral/cirugía , Neoplasias del Ventrículo Cerebral/diagnóstico por imagen , Seno Esfenoidal/cirugía , MasculinoRESUMEN
OBJECTIVE: The Maslach Burnout Inventory (MBI) is frequently used to assess occupational burnout and the Epidemic-Pandemic Impacts Inventory (EPII) is a new tool for assessing pandemic impacts. This study's objective is to describe chiropractic faculty members' experience of the COVID-19 pandemic, their burnout as professional educators, and their strategies for coping with stress. METHODS: A Qualtrics survey link was emailed to 73 current faculty and 10 previously employed faculty from 1 chiropractic school. The survey included 22 MBI, 31 EPII, and 2 questions about coping strategies. Faculty were given several weeks to complete the survey, were reminded via emails and meeting announcements, and were given paper surveys to increase participation. Responses were analyzed in STATA17. RESULTS: Forty-three faculty completed the survey (response rate = 52%). Of these, 25.8% reported testing positive for COVID-19, 30.23% reported difficulties transitioning to working from home, and 25.5% scored high on the MBI subscale for emotional exhaustion (EE) (mean 15.79, SD 13.68). Higher EE was associated with pandemic-related increases in mental health and sleep problems. Common coping strategies included self-care and social support. CONCLUSION: The majority of faculty reported neither contracting COVID-19 nor having difficulty transitioning to work from home. Average EE for participating faculty was lower than previous reports although a quarter scored high in EE, which may be associated with pandemic-related mental health and sleep problems. These results suggest chiropractic faculty might need support coming out of the COVID-19 pandemic and indicate the need for future research on burnout among faculty from other chiropractic institutions.
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BACKGROUND: Natural SARS-CoV-2 infection may elicit antibodies to a range of viral proteins including non-structural protein ORF8. RNA, adenovirus vectored and sub-unit vaccines expressing SARS-CoV-2 spike would be only expected to elicit S-antibodies and antibodies to distinct domains of nucleocapsid (N) protein may reliably differentiate infection from vaccine-elicited antibody. However, inactivated whole virus vaccines may potentially elicit antibody to wider range of viral proteins, including N protein. We hypothesized that antibody to ORF8 protein will discriminate natural infection from vaccination irrespective of vaccine type. METHODS: We optimized and validated the anti-ORF8 and anti-N C-terminal domain (NCTD) ELISA assays using sera from pre-pandemic, RT-PCR confirmed natural infection sera and BNT162b2 (BNT) or CoronaVac vaccinees. We then applied these optimized assays to a cohort of blood donor sera collected in April-July 2022 with known vaccination and self-reported infection status. RESULTS: We optimized cut-off values for the anti-ORF8 and anti-N-CTD IgG ELISA assays using receiver-operating-characteristic (ROC) curves. The sensitivity of the anti-ORF8 and anti-N-CTD ELISA for detecting past infection was 83.2% and 99.3%, respectively. Specificity of anti-ORF8 ELISA was 96.8 % vs. the pre-pandemic cohort or 93% considering the pre-pandemic and vaccine cohorts together. The anti-N-CTD ELISA specificity of 98.9% in the pre-pandemic cohort, 93% in BNT vaccinated and only 4 % in CoronaVac vaccinated cohorts. Anti-N-CTD antibody was longer-lived than anti-ORF8 antibody after natural infection. CONCLUSIONS: Anti-N-CTD antibody assays provide good discrimination between natural infection and vaccination in BNT162b2 vaccinated individuals. Anti-ORF8 antibody can help discriminate infection from vaccination in either type of vaccine and help estimate infection attack rates (IAR) in communities.
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COVID-19 , Vacunas Virales , Humanos , COVID-19/diagnóstico , COVID-19/prevención & control , Vacuna BNT162 , SARS-CoV-2 , Vacunación , Anticuerpos AntiviralesRESUMEN
BACKGROUND: The retrosigmoid craniotomy is a versatile surgical approach to the cerebellopontine angle though cerebrospinal fluid leak remains a concern, with a reported prevalence of 0-22 %. A host of closure materials and strategies have been proposed to achieve a watertight dural closure to varying degrees of success. We review our series of keyhole retrosigmoid craniotomies and describe our simple, standardized method of closure without watertight dural closure. METHODS: A retrospective review of all retrosigmoid craniotomies performed by the senior author was completed. Closure was achieved by placing an oversized piece of gelatin in the subdural space. The dura is grossly approximated. An oversized sheet of collagen matrix is placed as an overlay followed by gelatin sponge in the craniectomy defect held in place with titanium mesh. The superficial layers are approximated. The skin is closed with a running sub-cuticular suture followed by skin glue. Patient demographics, cerebrospinal fluid leak risk factors, and surgical outcomes were determined. RESULTS: A total of 114 patients were included. There was one case (0.9 %) of CSF leak, which resolved with placement of a lumbar drain for 5 days. The patient had one defined risk factor (morbid obesity, BMI 41.0 kg/m2). CONCLUSIONS: Obtaining a watertight dural layer closure has been the generally accepted strategy in preventing CSF leaks in a traditional retrosigmoid approach. In keyhole retrosigmoid approaches it may not be necessary by utilizing a simple gelfoam bolstered collagen matrix onlay technique potentially improving outcome measures including operative time.
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Pérdida de Líquido Cefalorraquídeo , Gelatina , Humanos , Pérdida de Líquido Cefalorraquídeo/cirugía , Craneotomía/métodos , Duramadre/cirugía , Procedimientos Neuroquirúrgicos/efectos adversos , Complicaciones Posoperatorias/etiología , Estudios RetrospectivosRESUMEN
Several zoonotic influenza A viruses detected in humans contain genes derived from avian H9N2 subtypes. We uncovered a Eurasian avian-like H1N1 swine influenza virus with polymerase basic 1 and matrix gene segments derived from the H9N2 subtype, suggesting that H9N2 viruses are infecting pigs and reassorting with swine influenza viruses in China.
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Subtipo H1N1 del Virus de la Influenza A , Subtipo H9N2 del Virus de la Influenza A , Gripe Humana , Infecciones por Orthomyxoviridae , Enfermedades de los Porcinos , Animales , Aves , China/epidemiología , Humanos , Subtipo H1N1 del Virus de la Influenza A/genética , Subtipo H9N2 del Virus de la Influenza A/genética , Gripe Humana/epidemiología , Infecciones por Orthomyxoviridae/veterinaria , Filogenia , Virus Reordenados/genética , Porcinos , Enfermedades de los Porcinos/epidemiologíaRESUMEN
Mutation in SP7, encoding the osteoblast-specific transcription factor SP7 (also known as osterix), has been described to cause osteogenesis imperfecta (OI) type XII. However, the exact dental phenotype has not been well described. We report the detailed dental manifestation of a boy known to have OI type XII, presented with impacted dentition, necessitating combined oral and maxillofacial surgical and orthodontic treatment. This case also highlighted the need of multidisciplinary team assessment in this group of children.
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Osteogénesis Imperfecta , Adolescente , Humanos , Mutación , Osteoblastos , Osteogénesis Imperfecta/complicaciones , Osteogénesis Imperfecta/genética , FenotipoRESUMEN
Studies with sensitive questions should include a sufficient number of respondents to adequately address the research interest. While studies with an inadequate number of respondents may not yield significant conclusions, studies with an excess of respondents become wasteful of investigators' budget. Therefore, it is an important step in survey sampling to determine the required number of participants. In this article, we derive sample size formulas based on confidence interval estimation of prevalence for four randomized response models, namely, the Warner's randomized response model, unrelated question model, item count technique model and cheater detection model. Specifically, our sample size formulas control, with a given assurance probability, the width of a confidence interval within the planned range. Simulation results demonstrate that all formulas are accurate in terms of empirical coverage probabilities and empirical assurance probabilities. All formulas are illustrated using a real-life application about the use of unethical tactics in negotiation.
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Modelos Estadísticos , Humanos , Tamaño de la Muestra , Prevalencia , Psicometría , Probabilidad , Simulación por Computador , Intervalos de ConfianzaRESUMEN
Exposure to ambient fine particulate matter (PM2.5) may contribute to brain injury, however, the molecular mechanisms have not yet been fully described. In this study, the human SH-SY5Y cells were treated with PM2.5 with different concentrations (0, 25, 100, and 250 µg/mL) for 24 h to investigate the cell apoptosis mediated by endoplasmic reticulum (ER) stress. The ratio of apoptosis, Ca2+ level, biomarkers of ER stress and apoptosis were determined. The results revealed that PM2.5 triggered the increase of apoptosis ratio and cellular Ca2+ levels. Compared with control, the expression of GRP78 and phosphorylation of IER1α and p38 were enhanced significantly in the cells under the conditions of PM2.5 exposure for activating ER stress signals. Besides, the key genes (CHOP/DR5/Caspase8/Caspase12) in ER stress-induced apoptosis signals were up-regulated after the PM2.5 treatment compared to the control. The results suggested PM2.5 induced apoptosis in SH-SY5Y cells by the stimulation of ER stress, which may be the potential mechanism of neurological diseases incurred by PM2.5.
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Apoptosis/efectos de los fármacos , Estrés del Retículo Endoplásmico/efectos de los fármacos , Material Particulado/efectos adversos , Western Blotting , Calcio/metabolismo , Línea Celular Tumoral , Ensayo de Inmunoadsorción Enzimática , Humanos , Reacción en Cadena en Tiempo Real de la PolimerasaRESUMEN
Surgical management of elevated intracranial pressures due to stroke or traumatic brain injury has classically been through decompressive craniectomy (DC). There is significant morbidity associated with DC including subdural hygromas, syndrome of the trephined, and the need for subsequent cranioplasty. Alternative techniques including the hinged and floating craniotomy have shown promise though can still suffer from complications associated with an unsecured bone flap. We report a case in which a patient who presented with an acute subdural hematoma and associated midline shift that was successfully treated with decompression via thinning and re-securing of the bone flap in a "split-thickness decompression."
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OBJECTIVE: Unique challenges can present in the treatment of small to mid-sized meningiomas that arise from the region of the anterior most aspect of the falx cerebri including its junction with the anterior skull base, what we call the far frontal region. Although this region of the anterior skull base is considered in the surgical approach of olfactory groove meningiomas invading this space, important differences exist between these tumors and those of the far frontal region. METHODS: Toward refining surgical selection, our cadaveric study details a minimally invasive keyhole superior interhemispheric approach to the far frontal region and 2 illustrative cases show the feasibility of this approach. RESULTS: Our cadaveric study defines 5 steps of the approach from the incision, craniectomy, dural opening, approaching the skull base and ipsilateral exposure, and finally falcine resection and bilateral skull base exposure. Two illustrative cases with the approach confirmed visualization of the full extent of tumor and gross total resection with preservation of the unaffected olfactory bulb. CONCLUSIONS: To the best of our knowledge, our anatomic study is distinctively unique in quantifying the working distance of the keyhole superior interhemispheric exposure and refining visualization of the far frontal region. We discuss these benefits and limitations (i.e., substantial involvement of tumor beyond midline) and differences with large meningiomas of the olfactory groove and far frontal region with significant posterior or lateral extension for which conventional exposures are appropriate.
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Craneotomía/métodos , Neoplasias Meníngeas/cirugía , Meningioma/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Neuroquirúrgicos/métodos , Neoplasias de la Base del Cráneo/cirugía , Anciano , Cadáver , Femenino , Humanos , Neoplasias Meníngeas/diagnóstico por imagen , Meningioma/diagnóstico por imagen , Persona de Mediana Edad , Neoplasias de la Base del Cráneo/diagnóstico por imagenRESUMEN
BACKGROUND: Metastatic nonsmall cell lung cancer (NSCLC) to the pituitary (NSCLC-PitM) is rare and often presents with visual field deficits. Surgical resection for the decompression of the optic apparatus has been the treatment of choice in such cases. Osimertinib is a third-generation tyrosine kinase inhibitor (TKI) approved for the treatment of patients with NSCLC with an epithelial growth factor receptor (EGFR) mutation though its role in the treatment of NSCLC-PitM that remains unclear. We present a case of NSCLC-PitM with optic chiasm compression and visual deficits that were successfully treated with osimertinib alone without surgical intervention. CASE DESCRIPTION: A 43-year-old male presented with pleuritic chest pain, fatigue, and visual deficits found to have NSCLC and a sellar mass with suprasellar extension and optic chiasm compression. Visual field testing demonstrated associated visual field deficits. Molecular testing was positive for EGFR exon 19 deletion. The patient was started on osimertinib with complete resolution of pituitary lesion and visual deficits at 4 weeks. CONCLUSION: Osimertinib is a third-generation EGFR-TKI that has demonstrated promising results among patients with metastatic EGFR-mutated NSCLC. While surgery is the mainstay of treatment in patients with a sellar mass, optic compression, and visual deficits, those with EGFR-mutated NSCLC-PitM may benefit from early initiation of such systemic therapies, rather than surgical intervention, with good ophthalmologic results.
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BACKGROUND: Tuberculum sellae meningiomas are challenging tumors often compressing the optic apparatus and involving the optic canals. Traditional approaches provide wide exposure, but optic canal access can remain difficult. Endonasal approaches offer a less invasive option that allows access to the medial optic canals, but larger tumors can still be challenging along with a higher risk of postoperative spinal fluid leak. We present the use of a keyhole superior interhemispheric approach for tuberculum sellae meningioma resection. METHODS: Five patients with tuberculum sellae meningioma who underwent a keyhole superior interhemispheric approach were retrospectively reviewed. Preoperative tumor volumes, visual outcomes, extent of resection, pathologic grading, perioperative complications, recurrence rates, operative times, and hospital length of stays were analyzed. RESULTS: The average age of the patients was 68.6 ± 7.7 years old (range 57-78). Average tumor volume was 8 ± 1.8 cm3. All patients had a gross total resection. Three out of 5 patients had World Health Organization grade 1 meningioma, and the other 2 had World Health Organization grade 2 meningioma. There were no recurrences over an average follow-up of 18.6 months (range 1-44). On preoperative visual assessment, 9 out of 10 eyes (90%) had a deficit. Postoperative visual assessment found 9 out of 9 eyes with preoperative deficits had improvement (100%). There were no perioperative or postoperative complications. CONCLUSIONS: The keyhole superior interhemispheric approach provides a transcranial alternative that allows excellent exposure of the vasculature and both optic canals, resulting in good extents of resection and recovery of vision.
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Meningioma/cirugía , Procedimientos Neuroquirúrgicos/métodos , Silla Turca/cirugía , Neoplasias de la Base del Cráneo/cirugía , Hueso Esfenoides/cirugía , Anciano , Craneotomía , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Neuroendoscopía , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Postoperative cerebral venous sinus thrombosis (pCVST) after resection of cerebellopontine angle and posterior fossa tumor resections occur almost exclusively in the lateral venous sinuses and are generally asymptomatic. Thrombus extension and involvement of the superior sagittal sinus (SSS) - a serious and potentially devastating complication - are rarely described and, as such, successful treatment for which is still poorly understood. We report a case of pCVST involving the SSS after translabyrinthine approach for resection of a metastatic neuroendocrine tumor (NET), and the first that was successfully treated with anticoagulation therapy. CASE DESCRIPTION: A 40-year-old man presented with headaches, diminished right-sided hearing, and ataxia was found to have a large right-sided cerebellopontine angle (CPA) lesion with extra-axial and possible intraparenchymal invasion. A retrosigmoid craniotomy for debulking and diagnosis was undertaken. Postoperative imaging revealed patent venous sinuses. Pathology confirmed NET. Further imaging revealed a likely pancreatic primary lesion. The patient then underwent subsequent translabyrinthine approach for definitive surgical resection. Postoperative imaging again revealed patent venous sinuses. The patient subsequently developed headaches on postoperative day 10 and was found to have pCVST involving the ipsilateral internal jugular to the SSS. The patient was started on therapeutic heparin with significant improvement in pCVST and symptoms. CONCLUSION: Extensive pCVST involving the SSS after CPA and posterior fossa tumor resections is extremely rare. Initial management with anticoagulation can yield promising results and should be initiated early in the clinical course unless otherwise contraindicated.
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BACKGROUND: Cerebrospinal fluid (CSF) leaks in the lateral recess of the sphenoid sinus (LRSS) are typically spontaneous in nature and require surgical repair. Endoscopic endonasal approaches have become the mainstay of CSF leak repair in the LRSS, though they remain technically challenging and place the vidian nerve (VN) and sphenopalatine artery (SPA) at risk. Here we present a lateral paraorbital approach (LPOA) as a minimally invasive transcranial VN and SPA sparing alternative for LRSS CSF leak repairs. CASE DESCRIPTION: A 41-year-old African American woman presented with headaches and was found to have a spontaneous CSF leak in the LRSS. A LPOA was used to repair the CSF leak. An incision was made along the frontal process of zygoma (FPZ). Removal of the overhanging portion of the FPZ while sparing the lateral orbital rim and retraction of the temporalis muscle allowed for a tangential approach to the LRSS. A small encephalocele was seen and resected; the defect was identified and repaired with onlay DuraGen (Integra LifeSciences, Princeton, NJ) and Dura Repair (J&J Medical Devices, New Brunswick, NJ). There were no postoperative complications or recurrence of CSF leak. CONCLUSIONS: The LPOA can be a useful alternative approach to the LRSS for CSF leak repair. The lateral-to-medial approach to defects in this area provides a shorter working distance while avoiding critical neurovascular structures.
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Pérdida de Líquido Cefalorraquídeo/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Neuroquirúrgicos/métodos , Órbita/cirugía , Seno Esfenoidal/cirugía , Adulto , Arterias Cerebrales/cirugía , Encefalocele/cirugía , Femenino , Cefalea/etiología , Humanos , Cirugía Endoscópica por Orificios Naturales , Obesidad Mórbida/complicaciones , Hueso Esfenoides/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Endoscopic endonasal transclival approaches provide direct access to the ventral skull base allowing the treating of clival and paraclival pathology without the manipulation of the brain or neurovascular structures. Postoperative spinal fluid leak, however, remains a challenge and various techniques have been described to reconstruct the operative defect. The "gasket seal" has been well-described, but has anatomic challenges when applied to clival defects. We describe a modification of this technique for use in endonasal transclival approaches. METHODS: Two patients who underwent an endoscopic endonasal transclival approach for tumor resection with an intraoperative spinal fluid leak underwent a modified "gasket seal" closure technique for skull base reconstruction. RESULTS: A 71-year-old woman with a petroclival meningioma and a 22 year old with a clival chordoma underwent endoscopic endonasal transclival resection with the modified repair. No new postoperative deficits occurred and no postoperative spinal fluid leak was seen with a follow-up of 17 and 23 months, respectively. CONCLUSION: We describe the successful use of a simple, low risk, and technique modification of the "gasket seal" technique adapted to the clivus that allows for hard reconstruction and facilitates placement of the nasoseptal flap.
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BACKGROUND: Basilar apex (BX) aneurysms are surgically challenging due to their anatomic location, need to traverse neurovascular structures, and proximity to multiple perforator arteries. Surgical approaches often require extensive bone resection and neurovascular manipulation. Visualization of low-lying BX aneurysms is typically obscured by the posterior clinoid and upper clivus and poses a unique challenge. Subtemporal or anterolateral approaches with a posterior clinoidectomy are often required to achieve adequate exposure, though these maneuvers can add invasiveness, risk, and morbidity to the procedure. Endoscopes and, more recently, fluoroscopic angiography capable endoscopes offer the possibility of providing improved visualization with less exposure allowing for minimally invasive clipping. CASE DESCRIPTION: We present the case of a 42-year-old female with incidentally found 5 mm middle cerebral artery and 5 mm BX aneurysms. She underwent a minimally invasive supraorbital keyhole craniotomy for the clipping of both aneurysms. While the posterior clinoid obstructed the necessary visualization for the BX aneurysm, use of endoscopy and endoscopic fluoroscopic angiography allowed for safe and successful clipping without the need for a posterior clinoidectomy. CONCLUSION: This represents the first reported case of a BX aneurysm clipping through a minimally invasive keyhole craniotomy using endoscopic indocyanine green video angiography. Use of endoscopic indocyanine green angiography, combined with keyhole endoscopic approaches, allows for safe minimally invasive clipping of challenging posterior circulation aneurysms.