Predicting future surgical steps during MCA aneurysm clipping using a multimodal transformer - Summary - MDSpire

Predicting future surgical steps during MCA aneurysm clipping using a multimodal transformer

  • By

  • Thomas J. On

  • Jonathan A. Tangsrivimol

  • Jiuxu Chen

  • Yuan Xu

  • Baoxin Li

  • Michael T. Lawton

  • Mark C. Preul

  • June 2, 2026

  • 0 min

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Objective:

To evaluate the feasibility of fixed-horizon surgical step prediction in recorded microscope videos of middle cerebral artery aneurysm clipping operations, highlighting the potential impact of AI in enhancing surgical precision.

Key Findings:
  • The multimodal model achieved the highest mean accuracy of 0.683 and weighted F1 score of 0.673, indicating strong predictive capabilities.
  • The annotation-only model had a mean accuracy of 0.606 and weighted F1 score of 0.577, suggesting the importance of prior knowledge.
  • The video-only model had a mean accuracy of 0.477 and weighted F1 score of 0.447, highlighting the limitations of using video features alone.
  • The multimodal model showed the best sequence-level alignment with a normalized edit distance of 0.430, reinforcing its superiority in predictive performance.
Interpretation:

Fixed-horizon surgical step prediction during MCA aneurysm clipping is feasible under controlled input conditions, with multimodal modeling providing the strongest predictive performance, which could enhance surgical training and decision-making.

Limitations:
  • The study represents upper-bound performance and requires validation in fully automated recognition-to-prediction pipelines, as well as consideration of potential biases in the data.
  • The analysis was limited to a small sample size of 25 surgeries, which may affect the generalizability of the findings.
Conclusion:

The findings indicate the potential for improved predictive modeling in surgical procedures, suggesting avenues for future research to validate and expand upon these results.

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