Carotico‐Clinoid Ligament Ossification: Unproven Risk to Internal Carotid Artery Flow
Bibliographic record
Abstract
The ossification of carotico-clinoid ligament (CCL) has been claimed to be a risk factor for blood flow compromise in the corresponding internal carotid artery (ICA). Despite its seriousness, this concept has not been distinctly examined in the literature. A systematic review following the PRISMA-statement was conducted. Searches were performed in PubMed, MEDLINE, Cochrane Library, and Neurosurgery Atlas GPT for the terms "carotico-clinoid ligament and foramen" in various formats. The clinical role of these structures (focusing on blood flow in ICA) was examined. A global survey targeting neuro-related doctors was conducted to capture the current perspectives of professionals in the field about these structures regarding compromising blood supply to ICA. A bibliometric analysis using Vos viewer was performed to visualize the status of these structures in literature. 59 publications were identified from 1935 through 2024 in the PubMed, MEDLINE, and Neurosurgery Atlas GPT databases. The majority of these publications came out in the last 12 years. No case reports supported the claim that ossified CCL could compromise the ICA and brain blood supply. There were 63 respondents from 14 different countries who addressed the questionnaire. Responses from five neuro-related specialties were analyzed, but neurologists (zero respondents). No one reported personal experience or awareness that CCF could compromise blood flow to the ICA. Vos viewer analysis showed that endoscopic neurosurgical approaches enhanced the understanding of CCL in the last decade. No evidence was found to support that the ossified CCL could compromise the ICA or brain blood supply.
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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 | 0.011 | 0.071 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.018 | 0.017 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
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".