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. 2020 Nov;162(11):2753-2758.
doi: 10.1007/s00701-020-04565-6. Epub 2020 Sep 15.

Diagnostic reliability of the Berlin classification for complex MCA aneurysms-usability in a series of only giant aneurysms

Lars Wessels  1 , Lucius Samo Fekonja  1 , Johannes Achberger  1 , Julius Dengler  1   2   3 , Marcus Czabanka  1 , Nils Hecht  1 , Ulf Schneider  1 , Dimitri Tkatschenko  1 , Karl-Michael Schebesch  4 , Nils Ole Schmidt  4   5 , Dorothee Mielke  6 , Henning Hosch  7 , Oliver Ganslandt  8 , Alexander Gräwe  9 , Bujung Hong  10 , Jan Walter  11   12 , Erdem Güresir  13 , Philippe Bijlenga  14 , Julien Haemmerli  1   14 , Nicolai Maldaner  15 , Serge Marbacher  16 , Ville Nurminen  17 , Hynek Zitek  18 , Ruben Dammers  19 , Naoki Kato  20 , Italo Linfante  21 , Maria-Teresa Pedro  22 , Karsten Wrede  23 , Wei-Te Wang  24 , Maria Wostrack  25 , Peter Vajkoczy  26
Affiliations

Diagnostic reliability of the Berlin classification for complex MCA aneurysms-usability in a series of only giant aneurysms

Lars Wessels et al. Acta Neurochir (Wien). 2020 Nov.

Abstract

Background and objective: The main challenge of bypass surgery of complex MCA aneurysms is not the selection of the bypass type but the initial decision-making of how to exclude the affected vessel segment from circulation. To this end, we have previously proposed a classification for complex MCA aneurysms based on the preoperative angiography. The current study aimed to validate this new classification and assess its diagnostic reliability using the giant aneurysm registry as an independent data set.

Methods: We reviewed the pretreatment neuroimaging of 51 patients with giant (> 2.5 cm) MCA aneurysms from 18 centers, prospectively entered into the international giant aneurysm registry. We classified the aneurysms according to our previously proposed Berlin classification for complex MCA aneurysms. To test for interrater diagnostic reliability, the data set was reviewed by four independent observers.

Results: We were able to classify all 51 aneurysms according to the Berlin classification for complex MCA aneurysms. Eight percent of the aneurysm were classified as type 1a, 14% as type 1b, 14% as type 2a, 24% as type 2b, 33% as type 2c, and 8% as type 3. The interrater reliability was moderate with Fleiss's Kappa of 0.419.

Conclusion: The recently published Berlin classification for complex MCA aneurysms showed diagnostic reliability, independent of the observer when applied to the MCA aneurysms of the international giant aneurysm registry.

Keywords: Cerebral bypass; Giant aneurysm; MCA aneurysm.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Overview of the classification for MCA aneurysm
Fig. 2
Fig. 2
Examples for each type of aneurysm out of the giant aneurysm registry set of cases
Fig. 3
Fig. 3
Percentage of cases for each type of aneurysm compared between the previously reported series of the Neurosurgical Department of the Charité University Medicine Berlin (BCN) compared with the series of cases provided by the giant aneurysm registry
Fig. 4
Fig. 4
Rating of every aneurysm by the different observers
See this image and copyright information in PMC

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