The complete anatomy of the superior cerebellar artery: a systematic review and meta-analysis with clinical implications.

BACKGROUND: The aim of this systematic review and meta-analysis was to provide a comprehensive quantitative evaluation of the origin, morphology, branching patterns, topography, and cranial nerve relationships of the superior cerebellar artery (SCA) to inform surgical planning and reduce iatrogenic risk. MATERIALS AND METHODS: A systematic search of major medical databases, including PubMed, Scopus, Embase, Web of Science, and the Cochrane Library, was performed to identify all relevant studies on SCA anatomy. RESULTS: Data from a total of 85 articles (1907-2026) were included. The pooled prevalence of a single SCA was 89.35% [95% confidence interval (CI): 86.56-91.85%]. The pooled prevalence of an SCA originating from a common trunk with the posterior cerebral artery (PCA) or directly from the proximal segment of the PCA was 1.18% (95% CI: 0.21-2.77%) and 2.21% (95% CI: 0.84-4.13%), respectively. The pooled mean outer diameter of the proximal SCA was 1.69 mm [standard error (SE) = 0.22] in cadaveric studies and 1.51 mm (SE = 0.16) in computed tomography (CT) studies. CONCLUSIONS: This systematic review and meta-analysis provide a comprehensive synthesis of the anatomical variability, morphometry, and neurovascular relationships of the superior cerebellar artery. Despite its generally consistent origin and course, clinically relevant variations are common and should be anticipated during surgical and radiological procedures involving the posterior fossa. Awareness of these patterns is essential to minimize iatrogenic injury, particularly to cranial nerves and perforating branches. The pooled quantitative data presented here may serve as a practical anatomical reference for safer surgical planning and more accurate imaging interpretation.