Partial Clipping and Multilayered Wrapping Using Collagen Matrix for Partially Thrombosed Basilar Trunk Aneurysm: A Technical Case Report

Round 1

Reviewer 1 Report

• In general, the idea and presentation accepted
• Need more details in the Intro section
• Time frame must be included in the discussion section between the time of initial diagnosis until the intervention 
• only 3/23 citations were new, Need to bring more recent citations 

Comments for author File: Comments.pdf

Author Response

We are very grateful to the reviewers for their insightful comments and suggestions, which would undoubtedly help us to improve our manuscript immensely. As indicated in the responses below, we have taken all their comments and suggestions into account when generating the revised version of the manuscript. Responses to the reviewers’ comments appear after the arrows, in blue text.

Reviewer #1:

Need more details in the Intro section

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Thank you for pointing out. I agree with the reviewer. I have described more about wrapping materials in the introduction section.

Time frame must be included in the discussion section between the time of initial diagnosis until the intervention

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Thank you for your comment.

I have added a sentence addressing the timing of the intervention in line 161-162.

Only 3/23 citations were new, Need to bring more recent citations

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Thank you for I have added recent studies to the reference.

Author Response File: Author Response.docx

Reviewer 2 Report

The authors present a case of a patient with a partially thrombosed, ruptured basilar trunk artery aneurysm successfully treated by clipping occlusion of the rupture point and multilayered wrapping of the aneurysmal dome. There are some points to be considered before acceptance:

Introduction

-Please use references in the introduction to validate each point.

Case report

-What was the patient’s baseline modified Rankin Scale (mRS)? SAH modified Fisher Scale? Final follow-up mRS?

-Are there more details about medical/surgical history? Comorbidities? Smoking? Family history of aneurysms? past interventions and their outcomes?

-Please provide the measurements of the aneurysm.

-Line 117,117 Left or right?

-Line 124-125 This could be moved to the methods section.

Discussion

-Line 134,135 please modify this sentence, or use quotation marks.

-Line 147-151 I could not find that being mentioned in the article at reference no6.

-Line 163-165 Please modify this sentence, or use quotation marks.

-Line 166-167 please make this statement less strong.

-Line 177 Related to what material? This could be more clear.

-What are the limitations of this approach? Any limitations of the wrapping materials?

Author Response

We are very grateful to the reviewers for their insightful comments and suggestions, which would undoubtedly help us to improve our manuscript immensely. As indicated in the responses below, we have taken all their comments and suggestions into account when generating the revised version of the manuscript. Responses to the reviewers’ comments appear after the arrows, in blue text.

Reviewer #2:

Please use references in the introduction to validate each point.

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I agree with your opinion. I have added the reference in the introduction section.

What was the patient’s baseline modified Rankin Scale (mRS)? SAH modified Fisher Scale? Final follow-up mRS?

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Thank you for your comments.

The baseline mRS was 0, SAH modified Fisher Scale was 3, Final follow-up mRS was 5. I have added these information into the manuscript.

Are there more details about medical/surgical history? Comorbidities? Smoking? Family history of aneurysms? past interventions and their outcomes?

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As you have pointed out, we have not included any detailed history of the patient. Unfortunately, the patient turned out to have no family that we could get in touch. Although we could communicate with the patient himself, he we could not obtain his social and medical background. I have included this circumstance in the manuscript.

Please provide the measurements of the aneurysm.

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Thank you for the comment. I have added the measurements in the manuscript.

Line 117,117 Left or right?

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Thank you for pointing out. The infarction occurred on the left side. I have modified the sentence.

Line 124-125 This could be moved to the methods section.

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I completely agree with the reviewer. However, because this is a case report, we don’t have the methods section. Therefore, I have moved it to the ”Informed Consent Statement” section in Line 209.

Discussion

Line 134,135 please modify this sentence, or use quotation marks.

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Thank you for the comment. I have added modified the sentence and added quotation marks.

Line 147-151 I could not find that being mentioned in the article at reference no6.

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Thank you for the comment. I have modified the sentence and added a new references to clarify our statement.

Line 163-165 Please modify this sentence, or use quotation marks.

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Thank you for the comment. I have added quotation marks.

Line 166-167 please make this statement less strong.

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Thank you for pointing out. I have changed the sentence to make the statement milder.

Line 177 Related to what material? This could be more clear.

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I agree with the reviewer. I have added examples of the material to the manuscript.

What are the limitations of this approach? Any limitations of the wrapping materials?

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Thank you for the comment. The limitation of this approach is that the surgical corridor is narrow and it can only be applied to aneurysm of adequate size and location.

The limitation of the wrapping material are that because it is a relatively novel product, more cases are needed to prove its efficacy and safety. I have added these in the manuscript.

Author Response File: Author Response.docx