E-017 endovascular management of iatrogenic anterior communication artery pseudoaneurysm
Bibliographic record
Abstract
Introduction Traumatic intracranial pseudoaneurysm following transphenoidal surgery has been described, but these typically involve the internal carotid artery and avulsion of the anterior communicating artery (AComm) is a very unusual complication. We present a case managed with endovascular repair. Case presentation A 80 year-old man underwent endoscopic transphenoidal surgery for endocrinologically-active pituitary adenoma. This patient had received pre- and post-op CTA. On postoperative CT angiography, the patient was noted to have a dramatic conformation change of the ACOM complex with splaying and a small new A1/A2 junction pseudoaneurysm indicating iatrogenic avulsion of the ACOM as the probable cause. The pseudoaneurysm had a narrow neck, therefore we elected to coil it. Other options including sacrifice of the A1/A2, flow diversion and surgery were considered and the pros and cons of these treatment options discussed. Under biplane fluoroscopic guidance, the pseudoaneurysm was accessed via microcatheter technique and coil embolization was performed. Following completion angiography to confirm no residual pseudoaneurysm, the patient was transferred in stable condition to the neuro-intensive care unit. At 6 month follow-up, the patient is well and possesses no neurological deficit. MR angiography showed no coil migration or residual pseudoaneurysm. Discussion Traditionally, this type of injury might be treated by vessel sacrifice or surgical intervention. Flow diversion might also be considered. We report here successful repair with conventional coiling approach with parent artery preservation for this very unusual iatrogenic injury. Disclosures A. Dmytriw: None. D. Sarma: None. W. Montanera: None. M. Cusimano: None. A. Bharatha: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".