Predicting neurological complications post clipping surgery in unruptured intracranial aneurysms using the NEURO score: a multi-center retrospective cohort study

Background: Predicting fatal neurological complications after clipping surgery for unrup-tured intracranial aneurysms (UIAs) is crucial; however, existing scoring systems are limited by narrow consideration of factors. We aimed to develop and validate a comprehensive risk stratification scoring system that incorporates patient-, aneurysm-, and operation-spe-cific variables for predicting postoperative neurological complications in UIA surgeries. Methods: This multi-center retrospective cohort study was conducted from September 2018 to October 2023. Patients undergoing clipping surgery for UIAs were divided into development and validation sets based on the treating institution. A predictive score for postoperative neurological complications was developed from a multivariate logistic regression analysis. The score, named NEURO, that incorporates variables like previous neurological disease, categorized aneurysm location and size, categorized operation time, and transfusion was validated externally. Results: The study included 2847 patients, with 1547 and 1300 in the development and validation sets, based on the institution of surgery, respectively. The incidence of neurological complications was 5.7% (88/1547) and 5.6% (73/1300) in the development and validation sets, respectively. The NEURO score showed good predictive ability with C-statistics of 0.720 (95% CI [0.667–0.776]) in the development set and 0.693 (95% CI [0.631–0.754]) in the validation set, demonstrating good calibration across the predicted probability range. Conclusions: The NEURO score, integrating multiple perioperative variables, may effec-tively predict the risk of neurological complications post UIA clipping surgery, aiding in identifying high-risk patients. This tool could enhance clinical decision-making and patient management in neurosurgical practice.