{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:37:14Z","timestamp":1789605434147,"version":"build-2803163510"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,26]],"date-time":"2025-07-26T00:00:00Z","timestamp":1753488000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,26]],"date-time":"2025-07-26T00:00:00Z","timestamp":1753488000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100006942","name":"Medical University of South Carolina","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100006942","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Distal posterior inferior cerebellar artery (PICA) dissecting aneurysms are rare, anatomically complex, and clinically underreported. Management strategies remain poorly standardized, and long-term outcomes are not well defined. This paper aims to systematically review the anatomical, clinical, and therapeutic characteristics of distal PICA dissecting aneurysms.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Following PRISMA guidelines, a comprehensive search of PubMed and SCOPUS identified 15 eligible studies, including 68 patients. Data on clinical presentation, aneurysm characteristics, treatment strategies, and outcomes were extracted. Pooled proportions and meta-analyses were conducted using random-effects models.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Among 68 patients, 91.2% presented with subarachnoid hemorrhage. Endovascular treatment was preferred (69.1%), achieving a higher complete occlusion rate (90%) and low retreatment (9%), and rebleeding rates (8%). Surgical treatment (23.5%) had similar efficacy (81% occlusion). The complete occlusion rate was not significantly different between the two (OR: 1.43; log OR = 0.360; 95% CI: \u20130.848 to 1.569, p\u2009=\u20090.559). Functional outcomes were favorable overall, with 79.4% of patients achieving mRS\u2009&lt;\u20092. Stroke was the most frequent complication (14.2%). No significant differences were found between reconstructive and deconstructive approaches (p\u2009=\u20090.971). Flow diversion was not utilized in any case.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Distal PICA dissecting aneurysms, though uncommon, pose a high risk of hemorrhage. Endovascular parent artery occlusion offers high occlusion rates with low morbidity. The absence of flow-diversion strategies highlights current device limitations and illustrates the need for anatomy-specific, prospective studies to guide optimal management.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00701-025-06603-7","type":"journal-article","created":{"date-parts":[[2025,7,26]],"date-time":"2025-07-26T05:21:33Z","timestamp":1753507293000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Distal posterior inferior cerebellar artery dissecting aneurysms: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"167","author":[{"given":"Mustafa","family":"Ismail","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norito","family":"Kinjo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rania H.","family":"Al-Taie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imad Samman","family":"Tahhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasna","family":"Loulida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro M.","family":"Spiotta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,26]]},"reference":[{"issue":"1","key":"6603_CR1","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.jclinepi.2013.08.003","volume":"67","author":"JJ Agnier","year":"2014","unstructured":"Agnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D (2014) The CARE guidelines: consensus-based clinical case reporting guideline development. J Clin Epidemiol 67(1):46\u201357. https:\/\/doi.org\/10.1016\/j.jclinepi.2013.08.003","journal-title":"J Clin Epidemiol"},{"issue":"6","key":"6603_CR2","doi-asserted-by":"publisher","first-page":"SHC1538","DOI":"10.1227\/01.NEU.0000333818.25520.90","volume":"62","author":"R Anxionnat","year":"2008","unstructured":"Anxionnat R, de Melo Neto JF, Bracard S, Lacour JC, Pinelli C, Civit T, Picard L (2008) Treatment of hemorrhagic intracranial dissections. Neurosurgery. 62(6):SHC1538-51","journal-title":"Neurosurgery."},{"key":"6603_CR3","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1007\/s00234-007-0333-y","volume":"50","author":"M Cellerini","year":"2008","unstructured":"Cellerini M, Mangiafico S, Ammannati F, Ambrosanio G, Muto M, Galasso L, Mennonna P (2008) Ruptured, dissecting posterior inferior cerebellar artery aneurysms: endovascular treatment without parent vessel occlusion. Neuroradiology 50:315\u2013320","journal-title":"Neuroradiology"},{"issue":"98","key":"6603_CR4","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1016\/j.wneu.2016.11.094","volume":"1","author":"Y Chung","year":"2017","unstructured":"Chung Y, Ryu J, Choi SK, Kim EJ, Choi JH, Lee SH (2017) Treatment strategy for isolated posterior inferior cerebellar artery dissection. World Neurosurgery 1(98):644\u2013653","journal-title":"World Neurosurgery"},{"issue":"3","key":"6603_CR5","doi-asserted-by":"publisher","first-page":"92","DOI":"10.5797\/jnet.ra.2023-0068","volume":"18","author":"J Haruma","year":"2024","unstructured":"Haruma J, Sugiu K, Ebisudani Y, Kimura R, Edaki H, Yamaoka Y, Kawakami M, Soutome Y, Hiramatsu M (2024) Endovascular treatment for intracranial artery dissections in posterior circulation. J Neuroendovascular Therapy 18(3):92\u2013102","journal-title":"J Neuroendovascular Therapy"},{"issue":"5","key":"6603_CR6","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1227\/00006123-199505000-00004","volume":"36","author":"T Tsukahara","year":"1995","unstructured":"Tsukahara T, Wada H, Satake K, Yaoita H, Takahashi A (1995) Proximal balloon occlusion for dissecting vertebral aneurysms accompanied by subarachnoid hemorrhage. Neurosurgery 36(5):914\u2013920","journal-title":"Neurosurgery"},{"issue":"6","key":"6603_CR7","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1227\/00006123-199106000-00021","volume":"28","author":"A Yamaura","year":"1991","unstructured":"Yamaura A, Isobe K, Karasudani H, Tanaka M, Komiya H (1991) Dissecting aneurysms of the posterior inferior cerebellar artery. Neurosurgery 28(6):894\u2013898","journal-title":"Neurosurgery"},{"key":"6603_CR8","doi-asserted-by":"crossref","unstructured":"Hiratsuka Y, Shindo K, Ohtake Y, Nakamura H (2024 Oct 19) Delayed diagnosis of a ruptured distal posterior inferior cerebellar artery (PICA) dissecting aneurysm presenting as craniocervical junction and spinal subdural hematoma. Cureus 16(10)","DOI":"10.7759\/cureus.71830"},{"issue":"4","key":"6603_CR9","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1177\/159101991201800410","volume":"18","author":"I Ioannidis","year":"2012","unstructured":"Ioannidis I, Nasis N, Andreou A (2012) Endovascular treatment of ruptured dissecting posterior inferior cerebellar artery aneurysms. Interv Neuroradiol 18(4):442\u2013448","journal-title":"Interv Neuroradiol"},{"issue":"2","key":"6603_CR10","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1097\/00006123-199808000-00107","volume":"43","author":"JJ Jafar","year":"1998","unstructured":"Jafar JJ, Kamiryo T, Chiles BW, Nelson PK (1998) A dissecting aneurysm of the posteroinferior cerebellar artery: case report. Neurosurgery 43(2):353\u2013356","journal-title":"Neurosurgery"},{"issue":"3","key":"6603_CR11","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1177\/1591019920968349","volume":"27","author":"NK Khattar","year":"2021","unstructured":"Khattar NK, White AC, Cruz AS, Adams SW, Meyer KS, Nauta HJ, Ding D, James RF (2021) Woven EndoBridge device for treatment of dissection-related PICA aneurysm. Interv Neuroradiol 27(3):388\u201390","journal-title":"Interv Neuroradiol"},{"issue":"02","key":"6603_CR12","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1055\/s-2004-818437","volume":"47","author":"G Kleinpeter","year":"2004","unstructured":"Kleinpeter G (2004) Why are aneurysms of the posterior inferior cerebellar artery so unique? Clinical experience and review of the literature. Min-Minim Invasive Neurosurg 47(02):93\u2013101","journal-title":"Min-Minim Invasive Neurosurg"},{"issue":"92","key":"6603_CR13","first-page":"580","volume":"1","author":"SH Lee","year":"2016","unstructured":"Lee SH, Moon JU, Choi SK, Choi MK, Lee J, Sung JY (2016) Pseudoaneurysm at the distal posterior inferior cerebellar artery after blunt head trauma: a case report and review of the literature. World Neurosurgery 1(92):580-e11","journal-title":"World Neurosurgery"},{"issue":"9","key":"6603_CR14","doi-asserted-by":"publisher","first-page":"2134","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.05.034","volume":"24","author":"H Li","year":"2015","unstructured":"Li H, Li XF, He XY, Zhang X, Zhu GH, Fang QR, Wang ZQ, Duan CZ (2015) Endovascular treatment of dissecting aneurysms of the posterior inferior cerebellar artery and predictors of outcome. J Stroke Cerebrovasc Dis 24(9):2134\u20132142","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"6","key":"6603_CR15","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.3174\/ajnr.A2014","volume":"31","author":"SM Lim","year":"2010","unstructured":"Lim SM, Choi IS, Hum BA, David CA (2010) Dissecting aneurysms of the distal segment of the posterior inferior cerebellar arteries: clinical presentation and management. Am J Neuroradiol 31(6):1118\u20131122","journal-title":"Am J Neuroradiol"},{"issue":"2","key":"6603_CR16","doi-asserted-by":"publisher","first-page":"240","DOI":"10.3390\/medicina58020240","volume":"58","author":"S Lim","year":"2022","unstructured":"Lim S, Lee K, Park H, Heo W, Hwang SH (2022) Overlapping pure LIVS Jr. stents for isolated ruptured dissecting aneurysm of the proximal posterior inferior cerebellar artery. Medicina 58(2):240","journal-title":"Medicina"},{"issue":"18","key":"6603_CR17","doi-asserted-by":"publisher","first-page":"3005","DOI":"10.7150\/ijms.49137","volume":"17","author":"HL Miao","year":"2020","unstructured":"Miao HL, Zhang DY, Wang T, Jiao XT, Jiao LQ (2020) Clinical importance of the posterior inferior cerebellar artery: a review of the literature. Int J Med Sci 17(18):3005","journal-title":"Int J Med Sci"},{"issue":"3","key":"6603_CR18","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1177\/159101990100700312","volume":"7","author":"AG Taylor","year":"2001","unstructured":"Taylor AG, Tymianski M, Terbrugge K (2001) A dissecting aneurysm of the posterior inferior cerebellar artery: a case report. Interv Neuroradiol 7(3):253\u2013257","journal-title":"Interv Neuroradiol"},{"issue":"1","key":"6603_CR19","doi-asserted-by":"publisher","first-page":"23","DOI":"10.3171\/JNS\/2008\/109\/7\/0023","volume":"109","author":"ES Nussbaum","year":"2008","unstructured":"Nussbaum ES, Madison MT, Myers ME, Goddard J, Janjua T (2008) Dissecting aneurysms of the posterior inferior cerebellar artery: retrospective evaluation of management and extended follow-up review in 6 patients. J Neurosurg 109(1):23\u201327","journal-title":"J Neurosurg"},{"issue":"2","key":"6603_CR20","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.clineuro.2004.01.007","volume":"107","author":"H Yamakawa","year":"2005","unstructured":"Yamakawa H, Kaku Y, Yoshimura SI, Ohkuma A, Sakai N (2005) Two cases of dissecting aneurysm of the distal posterior inferior cerebellar artery: possible involvement of segmental mediolytic arteriopathy in the pathogenesis. Clin Neurol Neurosurg 107(2):117\u2013122","journal-title":"Clin Neurol Neurosurg"},{"issue":"5","key":"6603_CR21","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1136\/neurintsurg-2014-011622","volume":"8","author":"AS Puri","year":"2016","unstructured":"Puri AS, Massari F, Hou SY, Lozano JD, Howk M, Perras M, Brooks C, Gounis MJ, Kan P, Wakhloo AK (2016) Onyx embolization in distal dissecting posterior inferior cerebellar artery aneurysms. J Neurointerventional Surg 8(5):501\u2013506","journal-title":"J Neurointerventional Surg"},{"key":"6603_CR22","doi-asserted-by":"crossref","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R (2021 Mar 29) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. bmj 372","DOI":"10.1136\/bmj.n71"},{"issue":"3","key":"6603_CR23","first-page":"194","volume":"64","author":"M Sharifi","year":"2005","unstructured":"Sharifi M, Cio\u0142kowski M, Krajewski P, Ciszek B (2005) The choroid plexus of the fourth ventricle and its arteries. Folia Morphol 64(3):194\u2013198","journal-title":"Folia Morphol"},{"issue":"03","key":"6603_CR24","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1055\/s-0042-1757432","volume":"18","author":"R Shintoku","year":"2023","unstructured":"Shintoku R, Marushima A, Okune S, Hiramine T, Nakao J, Takahashi T, Hino T, Hosoo H, Ito Y, Hayakawa M, Ishikawa E (2023) Endovascular embolization with n-butyl cyanoacrylate for ruptured distal posterior inferior cerebellar artery dissecting aneurysm. Asian J Neurosurg 18(03):651\u20135","journal-title":"Asian J Neurosurg"},{"key":"6603_CR25","doi-asserted-by":"publisher","first-page":"i4919","DOI":"10.1136\/bmj.i4919","volume":"355","author":"JA Sterne","year":"2016","unstructured":"Sterne JA, Hern\u00e1n MA, Reeves BC, Savovi\u0107 J, Berkman ND, Viswanathan M et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. https:\/\/doi.org\/10.1136\/bmj.i4919","journal-title":"BMJ"}],"container-title":["Acta Neurochirurgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06603-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00701-025-06603-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06603-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T04:31:29Z","timestamp":1757305889000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00701-025-06603-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,26]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6603"],"URL":"https:\/\/doi.org\/10.1007\/s00701-025-06603-7","relation":{},"ISSN":["0942-0940"],"issn-type":[{"value":"0942-0940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,26]]},"assertion":[{"value":"5 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval was not required for this systematic review and meta-analysis, as all data were obtained from previously published studies.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate and consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"206"}}