Complete cohort - Case 76 of 83
Case 91
Assigned out-of-fold recommendation
Flow diversion alone
Alternative: Coil embolization alone
View A is AP; View B is lateral, as confirmed by the data provider.
Case summary
A 57-year-old female presents with an incidental, unruptured 5.1 mm left superior hypophyseal aneurysm with a 2 mm neck, located proximal to the ophthalmic artery origin.
Image observation
On the supplied views, a saccular outpouching appears at the medial wall of the proximal supraclinoid internal carotid artery, with the ophthalmic artery origin visible distal to the lesion.
Model-generated clinical rationale
The assigned recommendation of flow diversion alone is supported by the aneurysm's location on the parent vessel wall, which is anatomically amenable to reconstructive techniques. However, the proximity to the ophthalmic artery origin introduces a risk of branch occlusion that is not fully addressed by the current documentation. The model's preference is weak, suggesting that the decision between flow diversion and coiling remains clinically ambiguous.
Model uncertainty
The OOF classifier scores for Flow diversion alone and Coil embolization alone were close, so the assigned recommendation should be treated as uncertain.
Clinical uncertainty / missing factor
The most significant missing decision factor is the precise morphological relationship between the aneurysm neck and the ophthalmic artery origin, which is critical for determining the safety of flow diversion versus the stability of coiling.
Explicit evidence used
5.1 mm x 4.3 mm x 3.6 mm medially projecting saccular aneurysm | 2 mm neck at the medial wall of the proximal supraclinoid segment