Giant, Unruptured, Partially Thrombosed Right Middle Cerebral Artery Aneurysm Treated with 2 Bypasses and Excision
Bibliographic record
Abstract
Aneurysms of the middle cerebral artery (MCA) account for up to 40% of all unruptured intracranial aneurysms 1 , 2 , 3 and 14%–20% of ruptured ones. 4 , 5 Giant MCA aneurysms are rare, representing 10% of cases, 6 but carry an aggressive natural history, with the Japanese Unruptured Cerebral Aneurysm Study reporting an annual rupture rate of approximately 17%. 7 Additionally, patients with unruptured giant MCA aneurysms can present with neurological symptoms, including headache, focal neurological deficit, seizure, or ischemia infarcts. Here, we report a 58-year-old man with a history of alcohol abuse, hypertension, diabetes, and smoking who presented after a first-time seizure ( Video 1 ). Imaging revealed an unruptured, giant (2.9 cm), partially thrombosed right MCA aneurysm. A microsurgical approach using clipping and bypass was planned due to the complexity of the aneurysm. The patient underwent a right frontotemporal craniotomy with radial artery graft extraction 6 weeks later, followed by 2 bypasses: an M2-to-M2 intracranial bypass and a right external carotid-to-M2 bypass using the radial artery graft. The aneurysm was successfully excised. An otolaryngologist assisted with the radial artery graft extraction during the craniotomy and neck dissection. This case highlights the technical complexities involved in managing giant aneurysms via microsurgical technique, including appropriate preoperative strategy development. Informed consent from next of kin as and institutional review board approval were obtained.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".