{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T06:05:16Z","timestamp":1780380316860,"version":"3.54.1"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Intracranial aneurysm clipping is technically demanding, with dynamic anatomy and evolving intraoperative decisions. Although AI has been applied to retrospective surgical phase recognition, near-future surgical step prediction remains largely unexplored in neurosurgery. This study evaluated the feasibility of fixed-horizon surgical step prediction in recorded microscope videos of middle cerebral artery aneurysm clipping operations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 25 uncomplicated MCA bifurcation aneurysm clipping surgeries by a single neurosurgeon, using 18 for training and 7 for independent testing. Cases were annotated into 12 standardized operative steps. A transformer-based prediction framework was evaluated with three input configurations: video features alone, prior human-annotated step labels alone, and combined video plus step-label inputs. With a sliding-window approach, each configuration used 1\u2005min of input data to predict the operative step labels occurring during the subsequent 1\u2005min. Performance was assessed by accuracy, weighted F1 score, and sequence-level agreement with ground truth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The multimodal model achieved the highest mean accuracy and weighted F1 score, 0.683 and 0.673, compared with 0.606 and 0.577 for the annotation-only model and 0.477 and 0.447 for the video-only model. The multimodal model also showed the best sequence-level alignment, with a normalized edit distance of 0.430 and edit score of 0.570.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Fixed-horizon surgical step prediction during MCA aneurysm clipping was feasible under controlled input conditions. Multimodal modeling provided the strongest predictive performance. These findings represent upper-bound performance and require validation in fully automated recognition-to-prediction pipelines.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1827725","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T05:42:37Z","timestamp":1780378957000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Predicting future surgical steps during MCA aneurysm clipping using a multimodal transformer"],"prefix":"10.3389","volume":"13","author":[{"given":"Thomas J.","family":"On","sequence":"first","affiliation":[{"name":"The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center","place":["Phoenix, Arizona"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan A.","family":"Tangsrivimol","sequence":"additional","affiliation":[{"name":"The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center","place":["Phoenix, Arizona"]},{"name":"Division of Neurosurgery, Department of Surgery, Chulabhorn Hospital, Chulabhorn Royal Academy","place":["Bangkok, Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiuxu","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Computing and Augmented Intelligence, Arizona State University","place":["Tempe, Arizona"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Xu","sequence":"additional","affiliation":[{"name":"The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center","place":["Phoenix, Arizona"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baoxin","family":"Li","sequence":"additional","affiliation":[{"name":"School of Computing and Augmented Intelligence, Arizona State University","place":["Tempe, Arizona"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Lawton","sequence":"additional","affiliation":[{"name":"The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center","place":["Phoenix, Arizona"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark C.","family":"Preul","sequence":"additional","affiliation":[{"name":"The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center","place":["Phoenix, Arizona"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","DOI":"10.1055\/b-002-66278","volume-title":"Seven Aneurysms: Tenets and Techniques for Clipping","author":"Lawton","year":"2011"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1554","DOI":"10.3171\/2022.3.JNS212939","article-title":"Complex cranial surgery and the future of open cerebrovascular training","volume":"137","author":"Graffeo","year":"2022","journal-title":"J Neurosurg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1227\/NEU.0b013e3182804aa2","article-title":"Current management of middle cerebral artery aneurysms: surgical results with a \u201cclip first\u201d 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Anticipating temporal occurrences of activities","volume-title":"(CVPR); 2018 Jun 18\u201322; Salt Lake City, UT, United States","author":"Abu Farha","year":"2018"},{"key":"B13","doi-asserted-by":"crossref","DOI":"10.1109\/ICCVW.2019.00151","article-title":"Uncertainty-aware anticipation of activities","volume-title":"(ICCVW); 2019 Oct 27\u2013Nov 2; Seoul, South Korea","author":"Abu Farha","year":"2019"},{"key":"B14","first-page":"3052","article-title":"Future transformer for long-term action anticipation","volume-title":"(CVPR); 2022 Jun 18\u201324; New Orleans, LA, United States","author":"Gong","year":"2022"},{"key":"B15","first-page":"5998","article-title":"Attention is all you need","volume-title":"Advances in Neural Information Processing Systems 30","author":"Vaswani","year":"2017"},{"key":"B16","doi-asserted-by":"publisher","first-page":"36","DOI":"10.31486\/toj.23.0118","article-title":"Training cerebrovascular and neuroendovascular surgery residents: a systematic literature review and recommendations","volume":"24","author":"Scullen","year":"2024","journal-title":"Ochsner J"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e336","DOI":"10.1016\/j.wneu.2021.02.027","article-title":"Microsurgical clipping versus advanced endovascular treatment of unruptured middle cerebral artery bifurcation aneurysms after a \u201cCoil-First\u201d policy","volume":"149","author":"Pflaeging","year":"2021","journal-title":"World Neurosurg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"075","DOI":"10.1055\/s-0040-1720996","article-title":"Surgical treatment of middle cerebral artery aneurysms: hints and precautions for young cerebrovascular surgeons","volume":"83","author":"Sturiale","year":"2022","journal-title":"J Neurol Surg A Cent Eur Neurosurg"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1827725\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T05:42:39Z","timestamp":1780378959000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1827725\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":18,"alternative-id":["10.3389\/fsurg.2026.1827725"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1827725","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,2]]},"article-number":"1827725"}}