Case Report: CASE OF ANTERIOR COMMUNICATING ARTERY (A.C.O.M.) ANEURYSM

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ANEURYSM", "datePublished": "2025-05-02T10:28:19", "dateModified": "2025-06-16T10:43:02", "author": [ { "@type": "Person", "name": "Utkarsh Warghane" }, { "@type": "Person", "name": "Neelakshi Shrivastava" }, { "@type": "Person", "name": "Sadhana Adhayapak" }, { "@type": "Person", "name": "Shucheta Yangad" }, { "@type": "Person", "name": "Vikas Makasare" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": "Anterior communicating artery (ACOM) aneurysms represent 23-40% of cerebral aneurysms and 12-15% of unruptured aneurysms, with a higher risk of rupture compared to other cerebral aneurysms. This case report presents a 56-year-old female admitted to a private hospital with acute headache and nausea, subsequently diagnosed with an ACOM aneurysm. The patient had no significant medical history, belonged to an intergenerational family, and maintained good mental health. Physical examination revealed a woman of thin frame (152 cm, 51 kg) with normal vital signs. Laboratory findings indicated low hemoglobin (7.5 g/dl), elevated sodium (19.1 mcg/dl), high creatinine (5.4 mcg), and elevated calcium (11.5 mcg/dl). Treatment included ondansetron, hydrochlorothiazide, potassium citrate, and alpha-blockers. The case highlights the importance of prompt intervention for ACOM aneurysms regardless of size, along with the necessity of comprehensive postoperative monitoring to detect complications such as bleeding and neurological impairments. Postoperative imaging is crucial to assess clipping effectiveness and monitor for potential complications." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-474", "name": "Case Report: CASE OF ANTERIOR COMMUNICATING ARTERY (A.C.O.M.) ANEURYSM" } } ] } Home Browse Case Report: CASE OF ANTERIOR COMMUNICATING ARTERY (A.C.O.M.) ANEURYSM ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Warghane U, Shrivastava N, Adhayapak S et al. Case Report: CASE OF ANTERIOR COMMUNICATING ARTERY (A.C.O.M.) ANEURYSM [version 2; peer review: 1 approved] . F1000Research 2025, 14 :474 ( https://doi.org/10.12688/f1000research.164317.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Revised Case Report: CASE OF ANTERIOR COMMUNICATING ARTERY (A.C.O.M.) ANEURYSM [version 2; peer review: 1 approved] Utkarsh Warghane https://orcid.org/0000-0002-8847-749X 1 , Neelakshi Shrivastava 2 , Sadhana Adhayapak 3 , Shucheta Yangad 4 , Vikas Makasare 1 Utkarsh Warghane https://orcid.org/0000-0002-8847-749X 1 , Neelakshi Shrivastava 2 , [...] Sadhana Adhayapak 3 , Shucheta Yangad 4 , Vikas Makasare 1 PUBLISHED 16 Jun 2025 Author details Author details 1 Nursing Perceptor, Dr D Y Patil Medical College Hospital and Research Centre, Pimpri, Pune, India 2 Nursing Director, Dr D Y Patil Medical College Hospital and Research Centre, Pimpri, Pune, India 3 Professor of Medical-Surgical Nursing, Dr. D. Y. Patil College of Nursing, Sant Tukaram Nagar, Pimpri, India 4 Associate Professor of Medical-Surgical Nursing, Dr D Y Patil College of Nursing, Sant Tukaram Nagar, Pimpri, India Utkarsh Warghane Roles: Resources, Writing – Original Draft Preparation, Writing – Review & Editing Neelakshi Shrivastava Roles: Validation, Visualization Sadhana Adhayapak Roles: Supervision, Validation, Visualization Shucheta Yangad Roles: Supervision, Validation, Writing – Review & Editing Vikas Makasare Roles: Resources, Supervision, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Anterior communicating artery (ACOM) aneurysms represent 23-40% of cerebral aneurysms and 12-15% of unruptured aneurysms, with a higher risk of rupture compared to other cerebral aneurysms. This case report presents a 56-year-old female admitted to a private hospital with acute headache and nausea, subsequently diagnosed with an ACOM aneurysm. The patient had no significant medical history, belonged to an intergenerational family, and maintained good mental health. Physical examination revealed a woman of thin frame (152 cm, 51 kg) with normal vital signs. Laboratory findings indicated low hemoglobin (7.5 g/dl), elevated sodium (19.1 mcg/dl), high creatinine (5.4 mcg), and elevated calcium (11.5 mcg/dl). Treatment included ondansetron, hydrochlorothiazide, potassium citrate, and alpha-blockers. The case highlights the importance of prompt intervention for ACOM aneurysms regardless of size, along with the necessity of comprehensive postoperative monitoring to detect complications such as bleeding and neurological impairments. Postoperative imaging is crucial to assess clipping effectiveness and monitor for potential complications. READ ALL READ LESS Keywords Anterior communicating artery aneurysm, cerebral aneurysm, clipping, endovascular therapy, postoperative monitoring, therapeutic intervention, neurological assessment, subarachnoid haemorrhage, microsurgical strategies, postoperative imaging Corresponding Author(s) Utkarsh Warghane ( [email protected] ) Close Corresponding author: Utkarsh Warghane Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Warghane U et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Warghane U, Shrivastava N, Adhayapak S et al. Case Report: CASE OF ANTERIOR COMMUNICATING ARTERY (A.C.O.M.) ANEURYSM [version 2; peer review: 1 approved] . F1000Research 2025, 14 :474 ( https://doi.org/10.12688/f1000research.164317.2 ) First published: 02 May 2025, 14 :474 ( https://doi.org/10.12688/f1000research.164317.1 ) Latest published: 16 Jun 2025, 14 :474 ( https://doi.org/10.12688/f1000research.164317.2 ) Revised Amendments from Version 1 Sincerely thank the reviewer for their constructive and insightful feedback, which has helped us enhance the quality and clarity of our case report. We are pleased to confirm that all the suggested revisions have been implemented as follows: Redundancy Removed: The duplicated surgical procedure paragraph has been deleted to improve readability and scientific integrity. Biochemical Data Corrected: All laboratory values have been revised with correct units and reference ranges. For example, sodium is now reported in mmol/L, creatinine in mg/dL, and calcium in mg/dL as per standard clinical norms. Discussion Clarified: The neurocognitive section has been refined to establish a clear clinical link to the patient’s condition. We have now connected the discussion on confabulation to possible ischemic damage in the basal forebrain and postoperative encephalopathy, aligning it more closely with the presented case. Terminology Defined: The abbreviation “I.O.R.” (Intraoperative Rupture) has been defined upon first use, and all abbreviations have been standardized throughout the manuscript. Functional Outcomes Added: We have included follow-up data, such as the modified Rankin Score at discharge and during outpatient review, to provide a clearer picture of the patient’s long-term neurological recovery. References Updated: All citations now follow the journal's referencing style consistently. We hope these revisions meet the reviewer’s expectations and elevate the manuscript to the required standard for indexed publication. Sincerely thank the reviewer for their constructive and insightful feedback, which has helped us enhance the quality and clarity of our case report. We are pleased to confirm that all the suggested revisions have been implemented as follows: Redundancy Removed: The duplicated surgical procedure paragraph has been deleted to improve readability and scientific integrity. Biochemical Data Corrected: All laboratory values have been revised with correct units and reference ranges. For example, sodium is now reported in mmol/L, creatinine in mg/dL, and calcium in mg/dL as per standard clinical norms. Discussion Clarified: The neurocognitive section has been refined to establish a clear clinical link to the patient’s condition. We have now connected the discussion on confabulation to possible ischemic damage in the basal forebrain and postoperative encephalopathy, aligning it more closely with the presented case. Terminology Defined: The abbreviation “I.O.R.” (Intraoperative Rupture) has been defined upon first use, and all abbreviations have been standardized throughout the manuscript. Functional Outcomes Added: We have included follow-up data, such as the modified Rankin Score at discharge and during outpatient review, to provide a clearer picture of the patient’s long-term neurological recovery. References Updated: All citations now follow the journal's referencing style consistently. We hope these revisions meet the reviewer’s expectations and elevate the manuscript to the required standard for indexed publication. See the authors' detailed response to the review by Rahul Shil READ REVIEWER RESPONSES Introduction An aneurysm is defined as a protrusion or bulge in a blood vessel that can rupture, resulting in intracranial bleeding. Anterior communicating artery (ACOM) aneurysms form at the convergence point of the internal and external carotid arteries in the brain. These represent the most common type of cerebral aneurysm, accounting for 23-40% of all cerebral aneurysms and 12-15% of unruptured aneurysms, with particularly high prevalence in patients under 30 years of age. 1 Treatment options for ACOM aneurysms include clipping, which involves surgically preventing aneurysm rupture by applying a small metal clip to its base. This procedure is typically performed under general anesthesia, requiring a small scalp incision and skull opening to access the aneurysm. 2 The International Study of Unruptured Intracranial Aneurysms (ISUIA) established an annual rupture risk of approximately 1% for anterior circulation aneurysms smaller than 7 mm. 3 However, recent research indicates that ACOM aneurysms smaller than 7 mm carry a disproportionately high rupture risk. Bijlenga et al. examined over 900 ACOM aneurysm cases with sizes ranging from 4-7 mm and found rupture risk comparable to posterior circulation aneurysms. 4 Lee et al. found that ACOM aneurysms were most frequently ruptured, with 47% of 200 patients with ruptured aneurysms having small (≤5 mm) aneurysms. Patients with hypertension showed an even higher propensity for microaneurysm (≤3 mm) rupture. 5 Advances in interventional materials and techniques have expanded treatment options to include endovascular approaches such as flow diverters and embolization. However, the complex anatomy of ACOM aneurysms—characterized by poor aspect ratio, catheter insertion difficulties, and potential impact on collateral blood flow—often limits the applicability of endovascular therapy. 6 The Barrow Ruptured Aneurysm Trial (BRAT) evaluated long-term outcomes for ACOM aneurysms, randomizing 39 patients (30%) to embolization and 91 patients (70%) to clipping. While 16.9% of embolization patients required conversion to surgical clipping due to complications, no patients transferred from clipping to embolization. After 1-3 years of follow-up, clinical outcomes were comparable between groups, though the clipping group demonstrated lower retreatment rates (3.3% vs 7.7%). 7 Case report The 56-year-old female patient initially presented to the private hospital with acute headache and nausea as her chief complaints. She appeared distressed but was fully alert, oriented to time, place, and person upon admission. The patient reported that her symptoms had begun suddenly and had progressively worsened over the previous 48 hours, prompting her to seek medical attention when over-the-counter pain relievers provided no relief. The patient’s medical history was unremarkable, with no previous instances of severe headaches, neurological symptoms, or prior hospitalizations. She belonged to an intergenerational family with good overall health and denied any family history of cerebrovascular diseases, asthma, or hypertension. Social history revealed that she was a non-smoker and did not consume alcohol. She reported experiencing significant marital stress as her husband had previously been unfaithful, though she maintained good relationships with other family members. Upon further questioning, the patient described developing sleep disturbances in the days preceding admission due to gastrointestinal and urinary discomfort. She reported experiencing pain in her abdomen and groin region, which had been intermittent at first but became more persistent as her headache worsened. She also noted mild nausea without vomiting and slight sensitivity to bright lights, though denied any fever, visual disturbances, or loss of consciousness. The patient expressed significant anxiety about her condition, particularly given its sudden onset. Physical examination revealed a thin-framed woman measuring 152 cm in height and weighing 51 kg, with normal vital signs except for a slightly elevated pulse rate. Her blood pressure was recorded at 110/70 mmHg. The patient appeared well-groomed and maintained good personal hygiene despite her distress. Neurological examination was initially unremarkable, with no focal deficits noted. Abdominal examination revealed atypical findings without rashes, tenderness, or purulent discharge. Initial blood work showed low hemoglobin at 10 g/dl, prompting further laboratory investigations. Comprehensive diagnostic evaluation revealed low hemoglobin (7.5 g/dl), elevated sodium (119.1 mg/dl), increased creatinine (1.4 mg), and high calcium (0.0 mg/dl). Neuroimaging studies subsequently confirmed the presence of an anterior communicating artery aneurysm. The patient was immediately started on a treatment regimen including ondansetron for nausea, hydrochlorothiazide to manage blood pressure, potassium citrate to address electrolyte imbalances, and alpha-blockers. The healthcare team discussed surgical intervention options with the patient and her family, emphasizing the importance of prompt treatment given the high rupture risk associated with ACOM aneurysms. After thorough evaluation and consultation with the neurosurgery team, the patient was scheduled for surgical clipping of the anterior communicating artery aneurysm. The procedure was deemed necessary due to the high rupture risk associated with ACOM aneurysms, particularly given the patient’s symptom presentation. The patient and her family were counseled regarding the risks, benefits, and alternatives to surgical intervention, after which informed consent was obtained. The patient underwent ACOM aneurysm clipping under general anesthesia. A pterional craniotomy approach was utilized to access the aneurysm. The procedure involved careful dissection of the sylvian fissure, identification of the anterior communicating artery complex, and successful application of a titanium clip across the neck of the aneurysm, effectively isolating it from circulation while preserving flow through the parent vessels. Intraoperative angiography confirmed complete obliteration of the aneurysm with patency of surrounding vasculature. The procedure was completed without complications, with minimal blood loss and stable hemodynamics. After thorough evaluation and consultation with the neurosurgery team, the patient was scheduled for surgical clipping of the anterior communicating artery aneurysm. The procedure was deemed necessary due to the high rupture risk associated with ACOM aneurysms, particularly given the patient’s symptom presentation. The patient and her family were counselled regarding the risks, benefits, and alternatives to surgical intervention, after which informed consent was obtained. A pterional craniotomy approach was utilized to access the aneurysm. The procedure involved careful dissection of the sylvian fissure, identification of the anterior communicating artery complex, and successful application of a titanium clip across the neck of the aneurysm, effectively isolating it from circulation while preserving flow through the parent vessels. Intraoperative angiography confirmed complete obliteration of the aneurysm with patency of surrounding vasculature. The procedure was completed without complications, with minimal blood loss and stable hemodynamics throughout. Postoperatively, the patient was transferred to the neurosurgical intensive care unit for close monitoring. She was maintained on a comprehensive medication regimen that included: Injection Ceftriaxone 1 gram intravenously every 12 hours for prophylactic antimicrobial coverage; Injection Pantoprazole 40 mg intravenously once daily for gastric protection; Nimodipine 60 mg orally every 4 hours to prevent cerebral vasospasm; Injection Phenytoin 100 mg intravenously every 8 hours for seizure prophylaxis; Injection Diclofenac 75 mg intravenously as needed for pain management; and Injection Mannitol 100 ml intravenously every 6 hours to control intracranial pressure. The patient initially exhibited mild postoperative drowsiness that gradually improved over the first 24 hours. Serial neurological examinations showed no focal deficits, with the patient regaining full orientation by postoperative day 2. Postoperative imaging on day 3 confirmed satisfactory clip placement with no evidence of cerebral ischemia or hemorrhage. Vital signs remained stable throughout the postoperative period, with blood pressure maintained within target range to prevent both hypoperfusion and hypertensive complications. Comprehensive nursing care was integral to the patient’s recovery and involved multiple dimensions of specialized care. The nursing team implemented rigorous vital signs monitoring, with hourly checks of blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation during the first 48 hours, transitioning to every 2 hours as the patient stabilized. Meticulous neurological assessments were performed every 2 hours using the Glasgow Coma Scale, along with pupillary response, limb strength, and cranial nerve function evaluations to detect any early signs of neurological deterioration or vasospasm. Pain management was carefully coordinated, with regular pain assessments using a numerical rating scale. Injection Diclofenac was administered as needed, with breakthrough pain managed according to established protocols. Preventive measures for common complications included early mobilization to prevent deep vein thrombosis, elevation of the head of bed to 30 degrees to optimize cerebral venous drainage, strict aseptic technique during wound care and intravenous line management to prevent infection, and careful fluid balance monitoring to prevent hypovolemia or fluid overload. The nursing team maintained cerebral perfusion through strict adherence to blood pressure parameters (systolic blood pressure maintained between 120-140 mmHg), administered medications with precision timing, particularly nimodipine for vasospasm prophylaxis, and monitored for adverse medication effects such as hypotension or liver function abnormalities. Additionally, they provided crucial emotional support to the patient and family members through clear communication about the recovery process, involvement in care planning, and reassurance during anxiety. A structured follow-up plan was implemented, and the patient was reviewed at 1-month and 3-month intervals postoperatively in the neurosurgical outpatient department. At 1-month follow-up, the patient reported mild fatigue but was otherwise functioning well. At the 3-month follow-up, the patient had resumed her household responsibilities and reported improved psychological well-being. A repeat CT angiogram confirmed stable clip placement with no residual aneurysm or new vascular pathology. Her mRS remained at 1, and the Barthel Index had improved to 100, indicating full independence in daily living. patient’s prognosis remained favorable with a high quality of life, and she was counseled about the importance of long-term follow-up and early reporting of any neurological symptoms. Discussion Possible ischemia to basal forebrain or orbitofrontal cortex, so few patients with a specific type of brain damage, which typically accounts for significant moments of momentary or behaviourally spontaneous confabulation, confabulate past the confusional stage. This holds for traumatic brain injury, diencephalic tumours, ruptured aneurysms, and alcoholic Korsakoff syndrome. Surprisingly, only a tiny percentage of these individuals later exhibit behaviourally spontaneous confabulation. Additionally, most people with this illness eventually cease making up stories and acquire a proper understanding of reality. 8 It appears that the structures necessary for thought to adjust to reality fail, which explains behaviorally spontaneous confabulation. A major global cause of mortality and disability is stroke. A significant cause of hemorrhagic stroke, aneurysmal subarachnoid haemorrhage (aSAH), continues to have a dismal prognosis. The best results come from early diagnosis and therapy. Multiple comorbidities are frequently present in individuals with subarachnoid haemorrhage (S.A.H.) and acute subarachnoid haemorrhage (aSAH), complicating anaesthesia management. 9 Selecting between A1-dominant and non-dominant hemisphere surgical techniques can be done using a straightforward categorisation approach that splits two categories of anterior communicating artery aneurysms. The first variety of anteriorly or inferiorly projecting haemorrhage patterns is restricted to the basal subarachnoid space or the opposing inferior frontal lobe and gyrus rectus, extends below the plane of ascending A2 vessels, and frequently adheres to the top of the visual system (as seen on lateral view). Early imaging of the contralateral A1 presents more of a challenge because of the inferior projection of this kind of aneurysm. Approaching this type of aneurysm from the side of the dominant A1 is almost usually preferred to prevent problems. 10 Those that extend superiorly or posteriorly between or behind the two A2 arteries fall into the second category. It can be challenging to see such small aneurysms due to the surrounding A2 vessels, especially when viewed from the side. 11 Our observations show that this lesion is the saccular anterior circulation aneurysm location that is missed the most frequently on a first arteriogram of fair grade. In unclear situations, further angiography, minutely precise oblique and enlarged images, and Finding the troublesome lesion could need 3D modelling of the communication zone with and without cross-compression of the opposing internal carotid artery. Gyrus rectus is among them. This aneurysm penetrates the interhemispheric fissure when the frontal lobe is initially elevated. This makes a surgical approach from the side of the dominant A1 less advantageous because it is straightforward to take proximal control of both A1 arteries before the commencement of aneurysm dissection. Conclusion Using the data from our analysis, we conclude that aneurysms more prominent than 4 mm, those with irregular or multilobulated walls, and those that are posteriorly or inferiorly oriented are all significantly related to an elevated risk of Intraoperative Rupture (I.O.R). There is a decreased risk of I.O.R. and a better outcome with temporary clipping of both A1 and Acomm aneurysms. By understanding the numerous risk factors that lead to I.O.R., the surgeon can anticipate it and be better equipped to handle it, even though the incidence of I.O.R. may never be eradicated. Because I.O.R. has a terrible prognosis, we should be very kind while managing aneurysms to prevent rupture. Additionally, a better approach in the surgical decision-making process may be possible with a more thorough understanding of the factors linked to the I.O.R. of the ACOMM aneurysm. Consent Written informed consent for publication of clinical details was obtained from the patient’s husband as the patient was experiencing significant cognitive impairment during the pre and post-operative recovery period following the neurosurgical intervention. The patient exhibited fluctuating levels of consciousness and difficulty with complex decision-making capacity as a result of temporary neurological effects following the clipping procedure for the anterior communicating artery aneurysm. The patient’s husband, as her legally recognized next of kin, provided surrogate consent after being thoroughly informed about the purpose, potential benefits, and risks of case publication. This consent process was documented in the patient’s medical record and was conducted in accordance with our institution’s ethics protocol. The consent was verified and countersigned by the attending physician to ensure ethical compliance. Data availability All data underlying the results are available as part of the article and no additional source data are required. Reporting guidelines Zenodo: CARE checklist for ‘CASE OF ANTERIOR COMMUNICATING ARTERY (A.C.O.M.) ANEURYSM’. https://doi.org/10.5281/zenodo.15282812 12 Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. Ajith JT, Christopher SO: Cerebral Aneurysms|National Institute of Neurological Disorders and Stroke.[cited 2025 Apr 17]. Reference Source 2. Harris L, Hill CS, Elliot M, et al. : Managing Anterior Communicating Artery Aneurysms—Are We Doing It Right? Neurosurgery . 2019 September; 66 (Supplement 1): pp. 310–673. Publisher Full Text 3. Abdul Hamid B, Bassel A, et al. : Intracranial Aneurysms in Autosomal Dominant Polycystic Kidney Disease: A Practical Approach to Screening and Management. Mayo Clinic Proceedings . 2025; 100 (6): 1030–1050. Publisher Full Text 4. Chen J, Li M, Zhu X, et al. : Anterior Communicating Artery Aneurysms: Anatomical Considerations and Microsurgical Strategies. Front Neurol. 2020 Sep; 8 (11): 1020–1050. PubMed Abstract | Publisher Full Text | Free Full Text 5. Lee WJ, Kim MK, Lim YC: Clinical analysis of young adult patients with ruptured intracranial aneurysms: a single-center study of 113 consecutive patients. J. Cerebrovasc. Endovasc. Neurosurg. 2020 Sep; 22 (3): 127–133. PubMed Abstract | Publisher Full Text | Free Full Text 6. Current Trends and Results of Endovascular Treatment of Unruptured Intracranial Aneurysms at a Single Institution in the Flow-Diverter Era. Am. J. Neuroradiol. [cited 2025 Apr 17]; 37 : 1106–1113. Publisher Full Text Reference Source 7. McDougall CG, Spetzler RF, Zabramski JM, et al. : The Barrow Ruptured Aneurysm Trial. J. Neurosurg. 2012 Jan; 116 (1): 135–144. Publisher Full Text 8. Wiggins A, Bunin JL: Confabulation. StatPearls. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Apr 17]. Reference Source 9. Brad E, Zacharia MD, et al. : Epidemiology of Aneurysmal Subarachnoid Hemorrhage. Neurosurgery Clinics of North America . 2010; 21 (2): 221–233. Publisher Full Text 10. Hassan T, Arafa O, Ibrahim T, et al. : Dominant A1 Direction as an Additional Factor for Deciding Surgical Approach for A1 Bifurcation Aneurysms. World Neurosurg. 2024 Feb 1; 182 : e126–e136. PubMed Abstract | Publisher Full Text 11. Minhyeong M, Dong-Kyu J, Byung-Rae C: Alternate Simultaneous Bilateral Carotid Angiography in Y-stent−Assisted Coil Embolization for an Anterior Communicating Artery Aneurysm with Triplicate A2 Variant. World Neurosurgery . 2023; 170 : 38–42. Publisher Full Text 12. Warghane U, Neelakshi S, Adhyapak DS, et al. : CASE OF ANTERIOR COMMUNICATING ARTERY (A.C.O.M.) ANEURYSM. Zenodo. 2025. Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 02 May 2025 ADD YOUR COMMENT Comment Author details Author details 1 Nursing Perceptor, Dr D Y Patil Medical College Hospital and Research Centre, Pimpri, Pune, India 2 Nursing Director, Dr D Y Patil Medical College Hospital and Research Centre, Pimpri, Pune, India 3 Professor of Medical-Surgical Nursing, Dr. D. Y. Patil College of Nursing, Sant Tukaram Nagar, Pimpri, India 4 Associate Professor of Medical-Surgical Nursing, Dr D Y Patil College of Nursing, Sant Tukaram Nagar, Pimpri, India Utkarsh Warghane Roles: Resources, Writing – Original Draft Preparation, Writing – Review & Editing Neelakshi Shrivastava Roles: Validation, Visualization Sadhana Adhayapak Roles: Supervision, Validation, Visualization Shucheta Yangad Roles: Supervision, Validation, Writing – Review & Editing Vikas Makasare Roles: Resources, Supervision, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 16 Jun 2025, 14:474 https://doi.org/10.12688/f1000research.164317.2 version 1 Published: 02 May 2025, 14:474 https://doi.org/10.12688/f1000research.164317.1 Copyright © 2025 Warghane U et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Warghane U, Shrivastava N, Adhayapak S et al. Case Report: CASE OF ANTERIOR COMMUNICATING ARTERY (A.C.O.M.) ANEURYSM [version 2; peer review: 1 approved] . F1000Research 2025, 14 :474 ( https://doi.org/10.12688/f1000research.164317.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 16 Jun 2025 Revised Views 0 Cite How to cite this report: Shil R. Reviewer Report For: Case Report: CASE OF ANTERIOR COMMUNICATING ARTERY (A.C.O.M.) ANEURYSM [version 2; peer review: 1 approved] . F1000Research 2025, 14 :474 ( https://doi.org/10.5256/f1000research.183523.r392418 ) The direct URL for this report is: https://f1000research.com/articles/14-474/v2#referee-response-392418 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 29 Jul 2025 Rahul Shil , Sapthagiri NPS University, Bengaluru, Karnataka, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.183523.r392418 All the previous review comments have been ... Continue reading READ ALL All the previous review comments have been addressed, and there are no further changes required. Competing Interests: No competing interests were disclosed. Reviewer Expertise: brain tumors, Breast cancer, CIPN, Cross-sectional study, RCT, Systematic review, and meta-analysis. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Shil R. Reviewer Report For: Case Report: CASE OF ANTERIOR COMMUNICATING ARTERY (A.C.O.M.) ANEURYSM [version 2; peer review: 1 approved] . F1000Research 2025, 14 :474 ( https://doi.org/10.5256/f1000research.183523.r392418 ) The direct URL for this report is: https://f1000research.com/articles/14-474/v2#referee-response-392418 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 02 May 2025 Views 0 Cite How to cite this report: Shil R. Reviewer Report For: Case Report: CASE OF ANTERIOR COMMUNICATING ARTERY (A.C.O.M.) ANEURYSM [version 2; peer review: 1 approved] . F1000Research 2025, 14 :474 ( https://doi.org/10.5256/f1000research.180808.r386047 ) The direct URL for this report is: https://f1000research.com/articles/14-474/v1#referee-response-386047 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 03 Jun 2025 Rahul Shil , Sapthagiri NPS University, Bengaluru, Karnataka, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.180808.r386047 I General Impression This manuscript provides a clinically relevant and detailed narrative of an anterior communicating artery (ACOM) aneurysm managed via microsurgical clipping. It offers insights into both the neurosurgical and nursing management perspectives, which broadens its educational value for ... Continue reading READ ALL I General Impression This manuscript provides a clinically relevant and detailed narrative of an anterior communicating artery (ACOM) aneurysm managed via microsurgical clipping. It offers insights into both the neurosurgical and nursing management perspectives, which broadens its educational value for an interdisciplinary readership. The clinical decision-making is well-justified, and the documentation of perioperative and postoperative care is thorough. II. Scientific and Clinical Rigor ✅ Strengths Comprehensive Case Documentation : The case presentation is enriched with a multidimensional profile, incorporating physical, biochemical, psychological, and social factors. Such detail enhances the translational relevance for both clinical practice and nursing education. Integration of Surgical and Nursing Paradigms : The manuscript excels in emphasizing postoperative nursing surveillance, such as frequent Glasgow Coma Scale monitoring and nimodipine titration, which are critical in subarachnoid hemorrhage (SAH) care to prevent delayed cerebral ischemia. Evidence-Supported Rationale : The authors appropriately cite contemporary literature (e.g., BRAT trial, ISUIA data) to support surgical intervention, particularly in small-sized aneurysms (<7 mm), where rupture risk is non-negligible. Ethical Transparency : The surrogate consent process is well-articulated, adhering to ethical principles in patients with transient postoperative cognitive impairment. III. Critical Limitations and Areas for Refinement �� Redundancy and Editorial Oversight The surgical intervention narrative is duplicated verbatim , which detracts from the manuscript’s scientific integrity. Redundancies of this nature should be corrected during editorial revision. ⚗️ Biochemical Data Inaccuracies There are critical unit errors in laboratory values: Sodium : Reported as “19.1 mcg/dl,” whereas the standard unit is mmol/L (normal range ~135–145 mmol/L). Creatinine and Calcium : Reported in “mcg” units rather than mg/dL or µmol/L , which impairs interpretability and could mislead clinical conclusions. Such misrepresentations must be rectified to preserve the scientific accuracy and clinical utility of the report. �� Discussion—Conceptual Discontinuity The initial portion of the discussion explores confabulation and neurocognitive dysfunction without an adequate mechanistic or clinical link to the patient’s presentation. If included, this neurobehavioral tangent must be explicitly connected to: Possible ischemic damage to the basal forebrain or orbitofrontal cortex, Transient postoperative encephalopathy due to vasospasm or surgical manipulation. ⚠️ Terminology Clarification The term I.O.R. (Intraoperative Rupture) is used frequently without a proper initial definition. All abbreviations should be expanded on first use and used consistently thereafter. Omission of Prognostic and Functional Outcome Data There is a lack of discussion regarding functional outcomes (e.g., modified Rankin Score, Barthel Index) or long-term follow-up data. Inclusion of this would elevate the clinical significance of the report. IV. Literature and Referencing The reference list is relevant and reflects current evidence-based standards, including microsurgical and endovascular treatment comparisons. However: Several citations are mentioned as “Reference Source” or “Indexer Full Text” without formalized citations. Uniform formatting in line with the journal referencing style is recommended. A concise synthesis of the anatomical variations of ACOM aneurysms from the cited neurovascular studies (e.g., Hassan et al.) would strengthen the anatomical rationale for the chosen surgical approach. V. Conclusion and Recommendations �� Overall Assessment : This case report contributes meaningfully to the clinical discourse on ACOM aneurysm management. Its strength lies in its comprehensive clinical approach and interdisciplinary focus. However, before acceptance for peer-reviewed Indexing, the following revisions are advised: ✅ Minor Revisions Required Category Action Item Technical Accuracy: Correct all laboratory units and reference ranges Redundancy: Eliminate duplicated surgical procedure paragraph Discussion Refinement: Link the neurocognitive commentary more clearly to case relevance Terminology Clarity: Define “I.O.R.” and standardize abbreviations Functional Outcome Details: Add long-term neurological or functional recovery data Reference Formatting: Ensure consistency and standardization of all cited sources Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: brain tumors, Breast cancer, CIPN, Cross-sectional study, RCT, Systematic review, and meta-analysis. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Shil R. Reviewer Report For: Case Report: CASE OF ANTERIOR COMMUNICATING ARTERY (A.C.O.M.) ANEURYSM [version 2; peer review: 1 approved] . F1000Research 2025, 14 :474 ( https://doi.org/10.5256/f1000research.180808.r386047 ) The direct URL for this report is: https://f1000research.com/articles/14-474/v1#referee-response-386047 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 23 Aug 2025 Utkarsh Warghane , Nursing Perceptor, Dr D Y Patil Medical College Hospital and Research Centre, Pimpri, Pune, India 23 Aug 2025 Author Response Sincerely thank the reviewer for their constructive and insightful feedback, which has helped us enhance the quality and clarity of our case report. We are pleased to confirm that all ... Continue reading Sincerely thank the reviewer for their constructive and insightful feedback, which has helped us enhance the quality and clarity of our case report. We are pleased to confirm that all the suggested revisions have been implemented as follows: Redundancy Removed : The duplicated surgical procedure paragraph has been deleted to improve readability and scientific integrity. Biochemical Data Corrected : All laboratory values have been revised with correct units and reference ranges. For example, sodium is now reported in mg/dL, creatinine in mg/dL, and calcium in mg/dL as per standard clinical norms. Discussion Clarified : The neurocognitive section has been refined to establish a clear clinical link to the patient’s condition. We have now connected the discussion on confabulation to possible ischemic damage in the basal forebrain and postoperative encephalopathy, aligning it more closely with the presented case. Terminology Defined : The abbreviation “I.O.R.” (Intraoperative Rupture) has been defined upon first use, and all abbreviations have been standardized throughout the manuscript. Functional Outcomes Added : We have included follow-up data, such as the modified Rankin Score at discharge and during outpatient review, to provide a clearer picture of the patient’s long-term neurological recovery. References Updated : All citations now follow the journal's referencing style consistently. We hope these revisions meet the reviewer’s expectations and elevate the manuscript to the required standard for indexed publication. With sincere appreciation, Utkarsh Warghane, on behalf of all co-authors Sincerely thank the reviewer for their constructive and insightful feedback, which has helped us enhance the quality and clarity of our case report. We are pleased to confirm that all the suggested revisions have been implemented as follows: Redundancy Removed : The duplicated surgical procedure paragraph has been deleted to improve readability and scientific integrity. Biochemical Data Corrected : All laboratory values have been revised with correct units and reference ranges. For example, sodium is now reported in mg/dL, creatinine in mg/dL, and calcium in mg/dL as per standard clinical norms. Discussion Clarified : The neurocognitive section has been refined to establish a clear clinical link to the patient’s condition. We have now connected the discussion on confabulation to possible ischemic damage in the basal forebrain and postoperative encephalopathy, aligning it more closely with the presented case. Terminology Defined : The abbreviation “I.O.R.” (Intraoperative Rupture) has been defined upon first use, and all abbreviations have been standardized throughout the manuscript. Functional Outcomes Added : We have included follow-up data, such as the modified Rankin Score at discharge and during outpatient review, to provide a clearer picture of the patient’s long-term neurological recovery. References Updated : All citations now follow the journal's referencing style consistently. We hope these revisions meet the reviewer’s expectations and elevate the manuscript to the required standard for indexed publication. With sincere appreciation, Utkarsh Warghane, on behalf of all co-authors Competing Interests: no competing interest Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 23 Aug 2025 Utkarsh Warghane , Nursing Perceptor, Dr D Y Patil Medical College Hospital and Research Centre, Pimpri, Pune, India 23 Aug 2025 Author Response Sincerely thank the reviewer for their constructive and insightful feedback, which has helped us enhance the quality and clarity of our case report. We are pleased to confirm that all ... Continue reading Sincerely thank the reviewer for their constructive and insightful feedback, which has helped us enhance the quality and clarity of our case report. We are pleased to confirm that all the suggested revisions have been implemented as follows: Redundancy Removed : The duplicated surgical procedure paragraph has been deleted to improve readability and scientific integrity. Biochemical Data Corrected : All laboratory values have been revised with correct units and reference ranges. For example, sodium is now reported in mg/dL, creatinine in mg/dL, and calcium in mg/dL as per standard clinical norms. Discussion Clarified : The neurocognitive section has been refined to establish a clear clinical link to the patient’s condition. We have now connected the discussion on confabulation to possible ischemic damage in the basal forebrain and postoperative encephalopathy, aligning it more closely with the presented case. Terminology Defined : The abbreviation “I.O.R.” (Intraoperative Rupture) has been defined upon first use, and all abbreviations have been standardized throughout the manuscript. Functional Outcomes Added : We have included follow-up data, such as the modified Rankin Score at discharge and during outpatient review, to provide a clearer picture of the patient’s long-term neurological recovery. References Updated : All citations now follow the journal's referencing style consistently. We hope these revisions meet the reviewer’s expectations and elevate the manuscript to the required standard for indexed publication. With sincere appreciation, Utkarsh Warghane, on behalf of all co-authors Sincerely thank the reviewer for their constructive and insightful feedback, which has helped us enhance the quality and clarity of our case report. We are pleased to confirm that all the suggested revisions have been implemented as follows: Redundancy Removed : The duplicated surgical procedure paragraph has been deleted to improve readability and scientific integrity. Biochemical Data Corrected : All laboratory values have been revised with correct units and reference ranges. For example, sodium is now reported in mg/dL, creatinine in mg/dL, and calcium in mg/dL as per standard clinical norms. Discussion Clarified : The neurocognitive section has been refined to establish a clear clinical link to the patient’s condition. We have now connected the discussion on confabulation to possible ischemic damage in the basal forebrain and postoperative encephalopathy, aligning it more closely with the presented case. Terminology Defined : The abbreviation “I.O.R.” (Intraoperative Rupture) has been defined upon first use, and all abbreviations have been standardized throughout the manuscript. Functional Outcomes Added : We have included follow-up data, such as the modified Rankin Score at discharge and during outpatient review, to provide a clearer picture of the patient’s long-term neurological recovery. References Updated : All citations now follow the journal's referencing style consistently. We hope these revisions meet the reviewer’s expectations and elevate the manuscript to the required standard for indexed publication. With sincere appreciation, Utkarsh Warghane, on behalf of all co-authors Competing Interests: no competing interest Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 02 May 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 2 (revision) 16 Jun 25 read Version 1 02 May 25 read Rahul Shil , Sapthagiri NPS University, Bengaluru, India Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Shil R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 29 Jul 2025 | for Version 2 Rahul Shil , Sapthagiri NPS University, Bengaluru, Karnataka, India 0 Views copyright © 2025 Shil R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions All the previous review comments have been addressed, and there are no further changes required. Competing Interests No competing interests were disclosed. Reviewer Expertise brain tumors, Breast cancer, CIPN, Cross-sectional study, RCT, Systematic review, and meta-analysis. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Shil R. Peer Review Report For: Case Report: CASE OF ANTERIOR COMMUNICATING ARTERY (A.C.O.M.) ANEURYSM [version 2; peer review: 1 approved] . F1000Research 2025, 14 :474 ( https://doi.org/10.5256/f1000research.183523.r392418) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-474/v2#referee-response-392418 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Shil R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 03 Jun 2025 | for Version 1 Rahul Shil , Sapthagiri NPS University, Bengaluru, Karnataka, India 0 Views copyright © 2025 Shil R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I General Impression This manuscript provides a clinically relevant and detailed narrative of an anterior communicating artery (ACOM) aneurysm managed via microsurgical clipping. It offers insights into both the neurosurgical and nursing management perspectives, which broadens its educational value for an interdisciplinary readership. The clinical decision-making is well-justified, and the documentation of perioperative and postoperative care is thorough. II. Scientific and Clinical Rigor ✅ Strengths Comprehensive Case Documentation : The case presentation is enriched with a multidimensional profile, incorporating physical, biochemical, psychological, and social factors. Such detail enhances the translational relevance for both clinical practice and nursing education. Integration of Surgical and Nursing Paradigms : The manuscript excels in emphasizing postoperative nursing surveillance, such as frequent Glasgow Coma Scale monitoring and nimodipine titration, which are critical in subarachnoid hemorrhage (SAH) care to prevent delayed cerebral ischemia. Evidence-Supported Rationale : The authors appropriately cite contemporary literature (e.g., BRAT trial, ISUIA data) to support surgical intervention, particularly in small-sized aneurysms (<7 mm), where rupture risk is non-negligible. Ethical Transparency : The surrogate consent process is well-articulated, adhering to ethical principles in patients with transient postoperative cognitive impairment. III. Critical Limitations and Areas for Refinement �� Redundancy and Editorial Oversight The surgical intervention narrative is duplicated verbatim , which detracts from the manuscript’s scientific integrity. Redundancies of this nature should be corrected during editorial revision. ⚗️ Biochemical Data Inaccuracies There are critical unit errors in laboratory values: Sodium : Reported as “19.1 mcg/dl,” whereas the standard unit is mmol/L (normal range ~135–145 mmol/L). Creatinine and Calcium : Reported in “mcg” units rather than mg/dL or µmol/L , which impairs interpretability and could mislead clinical conclusions. Such misrepresentations must be rectified to preserve the scientific accuracy and clinical utility of the report. �� Discussion—Conceptual Discontinuity The initial portion of the discussion explores confabulation and neurocognitive dysfunction without an adequate mechanistic or clinical link to the patient’s presentation. If included, this neurobehavioral tangent must be explicitly connected to: Possible ischemic damage to the basal forebrain or orbitofrontal cortex, Transient postoperative encephalopathy due to vasospasm or surgical manipulation. ⚠️ Terminology Clarification The term I.O.R. (Intraoperative Rupture) is used frequently without a proper initial definition. All abbreviations should be expanded on first use and used consistently thereafter. Omission of Prognostic and Functional Outcome Data There is a lack of discussion regarding functional outcomes (e.g., modified Rankin Score, Barthel Index) or long-term follow-up data. Inclusion of this would elevate the clinical significance of the report. IV. Literature and Referencing The reference list is relevant and reflects current evidence-based standards, including microsurgical and endovascular treatment comparisons. However: Several citations are mentioned as “Reference Source” or “Indexer Full Text” without formalized citations. Uniform formatting in line with the journal referencing style is recommended. A concise synthesis of the anatomical variations of ACOM aneurysms from the cited neurovascular studies (e.g., Hassan et al.) would strengthen the anatomical rationale for the chosen surgical approach. V. Conclusion and Recommendations �� Overall Assessment : This case report contributes meaningfully to the clinical discourse on ACOM aneurysm management. Its strength lies in its comprehensive clinical approach and interdisciplinary focus. However, before acceptance for peer-reviewed Indexing, the following revisions are advised: ✅ Minor Revisions Required Category Action Item Technical Accuracy: Correct all laboratory units and reference ranges Redundancy: Eliminate duplicated surgical procedure paragraph Discussion Refinement: Link the neurocognitive commentary more clearly to case relevance Terminology Clarity: Define “I.O.R.” and standardize abbreviations Functional Outcome Details: Add long-term neurological or functional recovery data Reference Formatting: Ensure consistency and standardization of all cited sources Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise brain tumors, Breast cancer, CIPN, Cross-sectional study, RCT, Systematic review, and meta-analysis. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 23 Aug 2025 Utkarsh Warghane, Nursing Perceptor, Dr D Y Patil Medical College Hospital and Research Centre, Pimpri, Pune, India Sincerely thank the reviewer for their constructive and insightful feedback, which has helped us enhance the quality and clarity of our case report. We are pleased to confirm that all the suggested revisions have been implemented as follows: Redundancy Removed : The duplicated surgical procedure paragraph has been deleted to improve readability and scientific integrity. Biochemical Data Corrected : All laboratory values have been revised with correct units and reference ranges. For example, sodium is now reported in mg/dL, creatinine in mg/dL, and calcium in mg/dL as per standard clinical norms. Discussion Clarified : The neurocognitive section has been refined to establish a clear clinical link to the patient’s condition. We have now connected the discussion on confabulation to possible ischemic damage in the basal forebrain and postoperative encephalopathy, aligning it more closely with the presented case. Terminology Defined : The abbreviation “I.O.R.” (Intraoperative Rupture) has been defined upon first use, and all abbreviations have been standardized throughout the manuscript. Functional Outcomes Added : We have included follow-up data, such as the modified Rankin Score at discharge and during outpatient review, to provide a clearer picture of the patient’s long-term neurological recovery. References Updated : All citations now follow the journal's referencing style consistently. We hope these revisions meet the reviewer’s expectations and elevate the manuscript to the required standard for indexed publication. With sincere appreciation, Utkarsh Warghane, on behalf of all co-authors View more View less Competing Interests no competing interest reply Respond Report a concern Shil R. Peer Review Report For: Case Report: CASE OF ANTERIOR COMMUNICATING ARTERY (A.C.O.M.) ANEURYSM [version 2; peer review: 1 approved] . F1000Research 2025, 14 :474 ( https://doi.org/10.5256/f1000research.180808.r386047) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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