Retrospective Application of Risk Scores to Unruptured Anterior Communicating Artery Aneurysms

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The author conducted a review of patients with unruptured anterior communicating artery aneurysms at a single center, assessing the concordance with real-world management using PHASES and UIATS. While I commend the author's efforts in conducting the study, I find the quality of the paper unsatisfactory, and the conclusions lack persuasiveness. Please refer to the following details:

1. Lack of Innovation in the Paper:

   The paper lacks innovation, and there are already related articles published on this topic.Such as:PMID: 32700160

2. Subjectivity in Single-Center Aneurysm Diagnosis:

   The diagnosis of aneurysms at a single center appears subjective, lacking objectivity.

3. Redundancy of Age in Factor Analysis:

    Factors such as age included in the factor analysis are already accounted for in the PHASES score. The significance of these factors in this table needs further consideration.

4. Disorderly Subheading Order and Punctuation Issues:

   The subheadings in the paper are disorderly, and there are issues with punctuation.There are two subheadings numbered 3.3 in the article.

I appreciate your attention to these concerns and look forward to improvements in future revisions of the manuscript.

Comments on the Quality of English Language

Comments on the Quality of English Language:

1.Clarity and Precision:

The overall clarity of the manuscript can be enhanced by carefully reviewing sentence structures. Some sentences appear convoluted, impacting the flow of ideas.

2.Grammar and Syntax:

There are instances of grammatical errors and awkward sentence constructions throughout the manuscript. A thorough proofreading for grammatical accuracy and proper syntax is recommended.

3.Vocabulary Usage:

Consider diversifying your vocabulary to convey ideas more precisely. Avoid repetitive word choices and explore synonyms where applicable.

4.Punctuation:

Address punctuation issues, including the use of commas, periods, and other punctuation marks. Proper punctuation enhances the readability of the text.

Sush as "[median age 51 (IQR 48, 57) vs.15972 (IQR 68, 77) years old]"

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This is a thoughtful analysis on applying scales namely PHASES and UIATS for decision making in management of UIAs. The results showed a concordance rate between both scales is 32%. When applying these scales on their already managed series of anterior communicating artery Unruptured aneurysms revealed a lower value in retrospect of both scales for different reasons on their actual decision making. Seemingly over treatment of some of those assigned as low risk or recommended for conservative management.

Their interpretation of the results was sound and clearly presented. Based on their findings it would be highly beneficial to design prospective multi centre studies including enough numbers taking into account not only the rupture risk but also the "true" morbidity of intervention and the impact of quality of life.  

 

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

I congratulate with you for the good job! The paper is scientifically well-based and well presented. I must stress only one point: if I understood well, the size of aneurysms you have treated is smaller than the untretaed one: if it is so, could you make a short comment on that in your discussion?

A comment aside: I come from an older generation of neurosurgeons with some expertise in the treatment of SAH, for which the only doubt, in the presence on an intracranial aneurysm which did not bleed yet, was if treating it openly or endovascularly. Then the epidemiological research went on and, with the help of more sophisticated and less invasive diagnostic technology, several guidelines came out and complicated algorythms were proposed in order to recommend a prospectively appropriare management for these patients harbouring un unpleasant Damocle's sword. I learned from this good paper that all these sophisticated recommandations have important limits, and need proper reviewing. I, and not only me I believe, strongly support the authors' suggestion to review them by implementing future, scientifically well-designed and appropriately conducted, studies

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I commend you for your diligence and responsiveness in dealing with comments and suggestions from reviewers. Your revisions have greatly improved the quality and clarity of your manuscript.