{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:05:45Z","timestamp":1789517145797,"version":"build-2803163510"},"reference-count":10,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"11","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"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":[[2026,9,14]]},"abstract":"\n BACKGROUND<\/jats:title>\n Large aneurysms arising from a fetal-type posterior cerebral artery (PCA) configuration pose substantial technical challenges, especially when ruptured and involving critical perforating vessels. Endovascular treatment may be limited when the aneurysm is large and incorporates the fetal PCA outflow.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 36-year-old woman presented with a ruptured large right posterior communicating artery aneurysm associated with a fetal-type PCA causing subarachnoid hemorrhage, intraventricular hemorrhage, hydrocephalus, and a symptomatic third nerve palsy. Because of the aneurysm\u2019s size and morphology, microsurgical clip reconstruction with adjunctive suction decompression (Dallas technique) was performed.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n The Dallas technique can safely and effectively facilitate aneurysm collapse and clip application. This method of retrograde suction decompression can help preserve the fetal PCA and anterior choroidal artery.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE26661<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case26661","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:48Z","timestamp":1789516848000},"source":"Crossref","is-referenced-by-count":0,"title":["Retrograde suction decompression (Dallas technique) and microsurgical clipping of large ruptured posterior communicating artery aneurysm associated with a fetal-type posterior cerebral artery: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"given":"Eva M.","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee Health Science Center, Memphis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho Jun","family":"Yun","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee Health Science Center, Memphis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6416-8553","authenticated-orcid":true,"given":"Mustafa","family":"Motiwala","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee Health Science Center, Memphis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0634-0582","authenticated-orcid":true,"given":"John E.","family":"Dugan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee Health Science Center, Memphis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke A.","family":"Silveira","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee Health Science Center, Memphis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nickalus R.","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee Health Science Center, Memphis"},{"name":"Department of Neurological Surgery, Semmes Murphey Clinic, Memphis, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"bib1","series-title":"Neurochirurgie","first-page":"361","article-title":"Epidemiology, genetic, natural history and clinical presentation of giant cerebral aneurysms","volume":"61","author":"Lonjon","year":"2015","unstructured":"Lonjon MPennes FSedat JBataille B.Epidemiology, genetic, natural history and clinical presentation of giant cerebral aneurysms. Neurochirurgie. 2015;61(6):361-365. doi:10.1016\/j.neuchi.2015.08.003"},{"issue":"24","key":"bib2","series-title":"N Engl J Med","first-page":"1725","article-title":"Unruptured intracranial aneurysms\u2014risk of rupture and risks of surgical intervention","volume":"339","author":"International Study of Unruptured Intracranial Aneurysms Investigators","year":"1998","unstructured":"International Study of Unruptured Intracranial Aneurysms Investigators.Unruptured intracranial aneurysms\u2014risk of rupture and risks of surgical intervention. N Engl J Med. 1998;339(24):1725-1733. doi:10.1056\/nejm199812103392401"},{"issue":"2","key":"bib3","series-title":"Oper Neurosurg","first-page":"171","article-title":"Open microsurgical versus endovascular management of unruptured and ruptured brain aneurysms","volume":"29","author":"Kim","year":"2024","unstructured":"Kim JEXu RJackson CMOpen microsurgical versus endovascular management of unruptured and ruptured brain aneurysms. Oper Neurosurg. 2024;29(2):171-180. doi:10.1227\/ons.0000000000001448"},{"issue":"1","key":"bib4","series-title":"BMC Neurol","first-page":"436","article-title":"Cerebral ischemia after treatment of posterior communicating artery aneurysms: clipping versus coiling","volume":"22","author":"Cai","year":"2022","unstructured":"Cai YZhang TZhao JCerebral ischemia after treatment of posterior communicating artery aneurysms: clipping versus coiling. BMC Neurol. 2022;22(1):436. doi:10.1186\/s12883-022-02962-1"},{"issue":"1","key":"bib5","series-title":"Surg Neurol Int","first-page":"101","article-title":"Microsurgical clipping for the true posterior communicating artery aneurysm in the distal portion of the posterior communicating artery","volume":"6","author":"Takeda","year":"2015","unstructured":"Takeda MKashimura HChida KMurakami T.Microsurgical clipping for the true posterior communicating artery aneurysm in the distal portion of the posterior communicating artery. Surg Neurol Int. 2015;6(1):101. doi:10.4103\/2152-7806.158515"},{"key":"bib6","series-title":"World Neurosurg","article-title":"Microsurgical clip reconstruction of a true posterior communicating artery aneurysm","volume":"185","author":"Dzhindzhikhadze","year":"2024","unstructured":"Dzhindzhikhadze RGadzhiagaev VZaytsev AMicrosurgical clip reconstruction of a true posterior communicating artery aneurysm. World Neurosurg. 2024;185:149. doi:10.1016\/j.wneu.2024.02.067"},{"issue":"4","key":"bib7","series-title":"J Neurosurg","first-page":"906","article-title":"Fetal-type posterior cerebral artery: the pitfall of parent artery occlusion for ruptured P2 segment and distal aneurysms","volume":"123","author":"Xu","year":"2015","unstructured":"Xu JXu LWu ZChen XYu JZhang J.Fetal-type posterior cerebral artery: the pitfall of parent artery occlusion for ruptured P2 segment and distal aneurysms. J Neurosurg. 2015;123(4):906-914. doi:10.3171\/2014.9.jns1442"},{"issue":"25","key":"bib8","series-title":"J Neurosurg Case Lessons","first-page":"CASE21240","article-title":"Selection of approach and bypass for fetal-type posterior cerebral artery aneurysm: illustrative cases","volume":"1","author":"Kikuta","year":"2021","unstructured":"Kikuta YYamaguchi KIshikawa TFunatsu TOkada YKawamata T.Selection of approach and bypass for fetal-type posterior cerebral artery aneurysm: illustrative cases. J Neurosurg Case Lessons. 2021;1(25):CASE21240. doi:10.3171\/case21240"},{"key":"bib9","series-title":"World Neurosurg","first-page":"128","article-title":"Modified orbitozygomatic craniotomy, anterior clinoidectomy, and retrograde suction decompression \u201cDallas technique\u201d for large unruptured clinoidal-ophthalmic segment aneurysm","volume":"174","author":"Nguyen","year":"2023","unstructured":"Nguyen VNParikh KAWu EArthur ASMichael LMKhan NR.Modified orbitozygomatic craniotomy, anterior clinoidectomy, and retrograde suction decompression \u201cDallas technique\u201d for large unruptured clinoidal-ophthalmic segment aneurysm. World Neurosurg. 2023;174:128. doi:10.1016\/j.wneu.2023.03.078"},{"issue":"3","key":"bib10","series-title":"Oper Neurosurg","first-page":"e161","article-title":"Retrograde suction decompression \u201cDallas Technique\u201d and microsurgical clipping of unruptured large carotid-ophthalmic aneurysm: 2-dimensional operative video","volume":"25","author":"Wu","year":"2023","unstructured":"Wu EMMorcos JJ.Retrograde suction decompression \u201cDallas Technique\u201d and microsurgical clipping of unruptured large carotid-ophthalmic aneurysm: 2-dimensional operative video. 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