{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:03Z","timestamp":1776096363309,"version":"3.50.1"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"11","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,3,16]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Double origin of the posterior inferior cerebellar artery (DOPICA) is a rare anatomical variation, and subarachnoid hemorrhage (SAH) due to DOPICA dissection has been reported. Although previous cases of SAH from DOPICA have been diagnosed as dissection based on imaging, reports of pathological confirmation of dissection as the source of hemorrhage are lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>Herein, the authors report the case of a 52-year-old man with an SAH caused by an intracranial DOPICA dissection. Surgical trapping of the dissected vessels was performed after direct visualization was obtained. Histopathological examination confirmed disruption of the internal elastic lamina and a hematoma within the media, which are typical findings of cerebral vascular dissection. Dissection occurred at the intersection of the vessel with the dentate ligament, suggesting that supporting structures may contribute to dissection in DOPICA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>To the authors\u2019 knowledge, this is the first report of a case in which cerebral vascular dissection was pathologically confirmed as the source of hemorrhage in an SAH associated with DOPICA. This case suggests that surrounding anatomical supporting structures may be involved in the etiology of dissection. In cases of SAH associated with DOPICA with uncertain vascular anatomy or bleeding source, surgical trapping via direct visualization should be considered as a treatment option.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25919\">https:\/\/thejns.org\/doi\/10.3171\/CASE25919<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25919","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:13:05Z","timestamp":1773925985000},"source":"Crossref","is-referenced-by-count":0,"title":["Double origin of the posterior inferior cerebellar artery dissection causing subarachnoid hemorrhage with pathological confirmation: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4085-7540","authenticated-orcid":true,"given":"Shinya","family":"Tabata","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoichi","family":"Harada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryo","family":"Hatanaka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0900-0505","authenticated-orcid":true,"given":"Haruka","family":"Kume","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroya","family":"Imai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Shimada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toru","family":"Hatayama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takuji","family":"Kono","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"J Neurosurg","first-page":"127","article-title":"Ruptured aneurysm on a double origin of the posterior inferior cerebellar artery: a pathological entity in an anatomical variation. Report of two cases and review of the literature","volume":"96","author":"Pasco","year":"2002","unstructured":"Pasco AThouveny FPapon XRuptured aneurysm on a double origin of the posterior inferior cerebellar artery: a pathological entity in an anatomical variation. Report of two cases and review of the literature. J Neurosurg. 2002;96(1):127-131. doi:10.3171\/jns.2002.96.1.0127"},{"issue":"5","key":"bib2","series-title":"Neurosurgery","first-page":"242","article-title":"Double origin of the posteroinferior cerebellar artery: angiographic anatomy and endovascular treatment of concurrent vertebrobasilar dissection","volume":"61","author":"Kwon","year":"2007","unstructured":"Kwon BJJung CIm SHLee DHHan MH.Double origin of the posteroinferior cerebellar artery: angiographic anatomy and endovascular treatment of concurrent vertebrobasilar dissection. Neurosurgery. 2007;61(5)(suppl 2):242-248. doi:10.1227\/01.neu.0000303976.22054.9d"},{"issue":"1","key":"bib3","series-title":"J Korean Neurosurg Soc","first-page":"40","article-title":"Dissecting aneurysm associated with a double origin of the posterior inferior cerebellar artery causing subarachnoid hemorrhage","volume":"51","author":"Koh","year":"2012","unstructured":"Koh JSLee CYLee SHKim GK.Dissecting aneurysm associated with a double origin of the posterior inferior cerebellar artery causing subarachnoid hemorrhage. J Korean Neurosurg Soc. 2012;51(1):40-43. doi:10.3340\/jkns.2012.51.1.40"},{"issue":"4","key":"bib4","series-title":"AJR Am J Roentgenol","first-page":"893","article-title":"Double origin of the posterior inferior cerebellar artery: association with intracranial aneurysm on catheter angiography","volume":"189","author":"Lesley","year":"2007","unstructured":"Lesley WSRajab MHCase RS.Double origin of the posterior inferior cerebellar artery: association with intracranial aneurysm on catheter angiography. AJR Am J Roentgenol. 2007;189(4):893-897. doi:10.2214\/AJR.07.2453"},{"issue":"3","key":"bib5","series-title":"NMC Case Rep J","first-page":"113","article-title":"A case of vertebral artery dissecting aneurysm with double origin of the posterior inferior cerebellar artery causing subarachnoid hemorrhage","volume":"7","author":"Horikoshi","year":"2020","unstructured":"Horikoshi KOishi HMitsuhashi TA case of vertebral artery dissecting aneurysm with double origin of the posterior inferior cerebellar artery causing subarachnoid hemorrhage. NMC Case Rep J. 2020;7(3):113-116. doi:10.2176\/nmccrj.cr.2019-0127"},{"issue":"2","key":"bib6","series-title":"J Neurosurg","first-page":"235","article-title":"The lateral spinal artery of the upper cervical spinal cord. Anatomy, normal variations, and angiographic aspects","volume":"63","author":"Lasjaunias","year":"1985","unstructured":"Lasjaunias PVallee BPerson HTer Brugge KChiu M.The lateral spinal artery of the upper cervical spinal cord. Anatomy, normal variations, and angiographic aspects. J Neurosurg. 1985;63(2):235-241. doi:10.3171\/jns.1985.63.2.0235"},{"issue":"1","key":"bib7","series-title":"J Neuroimaging","first-page":"65","article-title":"Retrograde back-coiling technique for a ruptured aneurysm of a double-origin posterior inferior cerebellar artery","volume":"19","author":"Vora","year":"2009","unstructured":"Vora NThomas AJHorowitz MBJovin T.Retrograde back-coiling technique for a ruptured aneurysm of a double-origin posterior inferior cerebellar artery. J Neuroimaging. 2009;19(1):65-67. doi:10.1111\/j.1552-6569.2008.00243.x"},{"issue":"3","key":"bib8","series-title":"Interv Neuroradiol","first-page":"351","article-title":"Intracranial aneurysms associated with a double origin of the posterior inferior cerebellar artery","volume":"17","author":"Trivelato","year":"2011","unstructured":"Trivelato FPSalles Rezende MTBrito Santos RHilton Vieira Madeira TCardoso Campos RCordeiro Ulh\u00f4a A.Intracranial aneurysms associated with a double origin of the posterior inferior cerebellar artery. 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Interv Neuroradiol. 2015;21(4):451-455. doi:10.1177\/1591019915590363"},{"issue":"3","key":"bib10","series-title":"Oper Neurosurg","first-page":"E8","article-title":"Surgical treatment of a double origin posterior inferior cerebellar artery aneurysm and insights from embryology: case report and literature review","volume":"13","author":"Silva","year":"2017","unstructured":"Silva MASee APAziz-Sultan MAPatel NJ.Surgical treatment of a double origin posterior inferior cerebellar artery aneurysm and insights from embryology: case report and literature review. Oper Neurosurg. 2017;13(3):E8-E12. doi:10.1093\/ons\/opx002"},{"issue":"3","key":"bib11","series-title":"Oper Neurosurg","first-page":"E314","article-title":"Reimplantation bypass using one limb of a double-origin posterior inferior cerebellar artery for treatment of a ruptured fusiform aneurysm: case report","volume":"19","author":"Lang","year":"2020","unstructured":"Lang MJCatapano JSPaisan GMReimplantation bypass using one limb of a double-origin posterior inferior cerebellar artery for treatment of a ruptured fusiform aneurysm: case report. Oper Neurosurg. 2020;19(3):E314-E319. doi:10.1093\/ons\/opaa016"},{"issue":"4","key":"bib12","series-title":"Neuroradiol J","first-page":"334","article-title":"Coiling for a saccular aneurysm on the caudal channel in double origin of the posterior inferior cerebellar artery","volume":"33","author":"Maeda","year":"2020","unstructured":"Maeda KTakagishi SKawano YCoiling for a saccular aneurysm on the caudal channel in double origin of the posterior inferior cerebellar artery. Neuroradiol J. 2020;33(4):334-339. doi:10.1177\/1971400920910644"},{"issue":"5","key":"bib13","series-title":"Neurosurgery","first-page":"905","article-title":"Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms","volume":"36","author":"Mizutani","year":"1995","unstructured":"Mizutani TAruga TKirino TMiki YSaito ITsuchida T.Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery. 1995;36(5):905-913. doi:10.1227\/00006123-199505000-00003"},{"issue":"1","key":"bib1","series-title":"J Neurosurg","first-page":"127","article-title":"Ruptured aneurysm on a double origin of the posterior inferior cerebellar artery: a pathological entity in an anatomical variation. Report of two cases and review of the literature","volume":"96","author":"Pasco","year":"2002","unstructured":"Pasco AThouveny FPapon XRuptured aneurysm on a double origin of the posterior inferior cerebellar artery: a pathological entity in an anatomical variation. Report of two cases and review of the literature. J Neurosurg. 2002;96(1):127-131. doi:10.3171\/jns.2002.96.1.0127"},{"issue":"5","key":"bib2","series-title":"Neurosurgery","first-page":"242","article-title":"Double origin of the posteroinferior cerebellar artery: angiographic anatomy and endovascular treatment of concurrent vertebrobasilar dissection","volume":"61","author":"Kwon","year":"2007","unstructured":"Kwon BJJung CIm SHLee DHHan MH.Double origin of the posteroinferior cerebellar artery: angiographic anatomy and endovascular treatment of concurrent vertebrobasilar dissection. Neurosurgery. 2007;61(5)(suppl 2):242-248. doi:10.1227\/01.neu.0000303976.22054.9d"},{"issue":"1","key":"bib3","series-title":"J Korean Neurosurg Soc","first-page":"40","article-title":"Dissecting aneurysm associated with a double origin of the posterior inferior cerebellar artery causing subarachnoid hemorrhage","volume":"51","author":"Koh","year":"2012","unstructured":"Koh JSLee CYLee SHKim GK.Dissecting aneurysm associated with a double origin of the posterior inferior cerebellar artery causing subarachnoid hemorrhage. J Korean Neurosurg Soc. 2012;51(1):40-43. doi:10.3340\/jkns.2012.51.1.40"},{"issue":"4","key":"bib4","series-title":"AJR Am J Roentgenol","first-page":"893","article-title":"Double origin of the posterior inferior cerebellar artery: association with intracranial aneurysm on catheter angiography","volume":"189","author":"Lesley","year":"2007","unstructured":"Lesley WSRajab MHCase RS.Double origin of the posterior inferior cerebellar artery: association with intracranial aneurysm on catheter angiography. AJR Am J Roentgenol. 2007;189(4):893-897. doi:10.2214\/AJR.07.2453"},{"issue":"3","key":"bib5","series-title":"NMC Case Rep J","first-page":"113","article-title":"A case of vertebral artery dissecting aneurysm with double origin of the posterior inferior cerebellar artery causing subarachnoid hemorrhage","volume":"7","author":"Horikoshi","year":"2020","unstructured":"Horikoshi KOishi HMitsuhashi TA case of vertebral artery dissecting aneurysm with double origin of the posterior inferior cerebellar artery causing subarachnoid hemorrhage. NMC Case Rep J. 2020;7(3):113-116. doi:10.2176\/nmccrj.cr.2019-0127"},{"issue":"2","key":"bib6","series-title":"J Neurosurg","first-page":"235","article-title":"The lateral spinal artery of the upper cervical spinal cord. Anatomy, normal variations, and angiographic aspects","volume":"63","author":"Lasjaunias","year":"1985","unstructured":"Lasjaunias PVallee BPerson HTer Brugge KChiu M.The lateral spinal artery of the upper cervical spinal cord. Anatomy, normal variations, and angiographic aspects. J Neurosurg. 1985;63(2):235-241. doi:10.3171\/jns.1985.63.2.0235"},{"issue":"1","key":"bib7","series-title":"J Neuroimaging","first-page":"65","article-title":"Retrograde back-coiling technique for a ruptured aneurysm of a double-origin posterior inferior cerebellar artery","volume":"19","author":"Vora","year":"2009","unstructured":"Vora NThomas AJHorowitz MBJovin T.Retrograde back-coiling technique for a ruptured aneurysm of a double-origin posterior inferior cerebellar artery. J Neuroimaging. 2009;19(1):65-67. doi:10.1111\/j.1552-6569.2008.00243.x"},{"issue":"3","key":"bib8","series-title":"Interv Neuroradiol","first-page":"351","article-title":"Intracranial aneurysms associated with a double origin of the posterior inferior cerebellar artery","volume":"17","author":"Trivelato","year":"2011","unstructured":"Trivelato FPSalles Rezende MTBrito Santos RHilton Vieira Madeira TCardoso Campos RCordeiro Ulh\u00f4a A.Intracranial aneurysms associated with a double origin of the posterior inferior cerebellar artery. Interv Neuroradiol. 2011;17(3):351-356. doi:10.1177\/159101991101700312"},{"issue":"4","key":"bib9","series-title":"Interv Neuroradiol","first-page":"451","article-title":"Treatment of a ruptured aneurysm involved in a double origin of the posterior inferior cerebellar artery","volume":"21","author":"Uchiyama","year":"2015","unstructured":"Uchiyama TOkamoto HOgata ATajima YTakase YSuzuyama K.Treatment of a ruptured aneurysm involved in a double origin of the posterior inferior cerebellar artery. Interv Neuroradiol. 2015;21(4):451-455. doi:10.1177\/1591019915590363"},{"issue":"3","key":"bib10","series-title":"Oper Neurosurg","first-page":"E8","article-title":"Surgical treatment of a double origin posterior inferior cerebellar artery aneurysm and insights from embryology: case report and literature review","volume":"13","author":"Silva","year":"2017","unstructured":"Silva MASee APAziz-Sultan MAPatel NJ.Surgical treatment of a double origin posterior inferior cerebellar artery aneurysm and insights from embryology: case report and literature review. Oper Neurosurg. 2017;13(3):E8-E12. doi:10.1093\/ons\/opx002"},{"issue":"3","key":"bib11","series-title":"Oper Neurosurg","first-page":"E314","article-title":"Reimplantation bypass using one limb of a double-origin posterior inferior cerebellar artery for treatment of a ruptured fusiform aneurysm: case report","volume":"19","author":"Lang","year":"2020","unstructured":"Lang MJCatapano JSPaisan GMReimplantation bypass using one limb of a double-origin posterior inferior cerebellar artery for treatment of a ruptured fusiform aneurysm: case report. Oper Neurosurg. 2020;19(3):E314-E319. doi:10.1093\/ons\/opaa016"},{"issue":"4","key":"bib12","series-title":"Neuroradiol J","first-page":"334","article-title":"Coiling for a saccular aneurysm on the caudal channel in double origin of the posterior inferior cerebellar artery","volume":"33","author":"Maeda","year":"2020","unstructured":"Maeda KTakagishi SKawano YCoiling for a saccular aneurysm on the caudal channel in double origin of the posterior inferior cerebellar artery. Neuroradiol J. 2020;33(4):334-339. doi:10.1177\/1971400920910644"},{"issue":"5","key":"bib13","series-title":"Neurosurgery","first-page":"905","article-title":"Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms","volume":"36","author":"Mizutani","year":"1995","unstructured":"Mizutani TAruga TKirino TMiki YSaito ITsuchida T.Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. 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