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This video demonstrates the surgical challenge associated with AChA aneurysms because of the proximity of adjacent structures and highlights the importance of meticulous technique during clip application. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona. Copyright © 2020 by the Congress of Neurological Surgeons.BACKGROUND The unfavourable safety profile of aminoglycosides and the