Patient Outcomes from 92 Consecutive Saccular Middle Cerebral Artery Aneurysm Clipping
Bibliographic record
Abstract
Background: Despite the advances in endovascular treatment, MCA aneurysms are deemed to be more appropriate for microsurgical clipping, especially due to the high occlusion rate and treatment durability. Methods: We retrospectively reviewed patients who underwent microsurgical clipping of saccular MCA aneurysms from January 2014 to December 2021 by a single surgeon at our institution. We examined outcomes including modified Rankle scale (mRS) at discharge and long-term follow-up, occlusion rate, recanalization rate and occurrence of new neurological morbidities. Results: We identified 92 consecutive MCA aneurysm clipping that met the inclusion criteria, including 46 operations involving ruptured aneurysms and 46 with unruptured aneurysm. For the entire cohort, 79.3% had good outcome (mRS: 0–2) at long-term follow-up, including all those who underwent elective clipping of unruptured MCA aneurysms. Factors associated with poor outcome at the time of the discharge for the entire cohort included older age (>65, OR: 3.0, 95% CI: 1.11–7.96, p = 0.03), occurrence of new postoperative neurological morbidities (OR: 4.8, 95% CI: 1.55–14.94, p = 0.006) and aneurysm rupture (OR: 13.13, 95% CI: 3.56–48.47, p < 0.001). Older age remained the single correlate for poor long-term outcome (OR: 3.4, 95% CI: 1.05–10.81, p = 0.04). For the ruptured cohort, predictors for poor long-term outcome included hemiparesis at the time of aneurysm rupture (OR: 8.66, 95% CI: 1.47–50.91, p = 0.017), clinical vasospasm requiring treatment OR: 5.33, 95% CI: 1.22–23.19, p = 0.026), and infarction related to vasospasm (OR: 6.5, 95% CI: 1.08–39.11, p = 0.041). Older age ( p = 0.046) and more complex anatomy/presence of lobulation and daughter sac ( p = 0.036) were predictors of new postoperative neurological morbidities in patients who underwent elective MCA aneurysm clipping. Aneurysm occlusion was achieved in all patients except one (99%) with near-complete occlusion. The effect of MCA aneurysm clipping was durable, with only one patient (1%) requiring retreatment at long-term follow-up. Conclusions: MCA aneurysm clipping is very safe and durable in our surgically treated cohort and should be considered as the first treatment option for patients with saccular MCA aneurysms, especially in centers with abundant surgical experience. Publication History Article published online: 01 February 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".