{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T07:56:19Z","timestamp":1786866979865,"version":"build-2736575974"},"reference-count":16,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"11","license":[{"start":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T00:00:00Z","timestamp":1694390400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Cranial and spinal cerebrospinal fluid (CSF) leaks are associated with opposite CSF fluid dynamics. The differing pathophysiology between spontaneous cranial and spinal CSF leaks are, therefore, mutually exclusive in theory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 66-year-old female presented with tension pneumocephalus. The patient underwent computed tomography (CT) scanning, which demonstrated left-sided tension pneumocephalus, with an expanding volume of air directly above a bony defect of the tegmen tympani and mastoideum. The patient underwent a left middle fossa craniotomy for repair of the tegmen CSF leak. In the week after discharge, she developed a recurrence of positional headaches and underwent head CT. Further magnetic resonance imaging of the brain and thoracic spine showed bilateral subdural hematomas and multiple meningeal diverticula.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Cranial CSF leaks are caused by intracranial hypertension and are not associated with subdural hematomas. Clinicians should maintain a high index of suspicion for intracranial hypotension due to spinal CSF leak whenever \u201cotogenic\u201d pneumocephalus is found. Close postoperative follow-up and clinical monitoring for symptoms of intracranial hypotension in any patients who undergo repair of a tegmen defect for otogenic pneumocephalus is recommended.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case23300","type":"journal-article","created":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T20:28:11Z","timestamp":1694464091000},"source":"Crossref","is-referenced-by-count":2,"title":["Tandem cranial and spinal cerebrospinal fluid leaks presenting with otogenic tension pneumocephalus: illustrative case"],"prefix":"10.3171","volume":"6","author":[{"given":"Dominic","family":"Chau","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, House Institute, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary R","family":"Barnard","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, House Institute, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J","family":"Muelleman","sequence":"additional","affiliation":[{"name":"Division of Neuro-otology, House Institute, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam M","family":"Olszewski","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, House Institute, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna K","family":"D\u2019Agostino","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, House Institute, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel M","family":"Maya","sequence":"additional","affiliation":[{"name":"Imaging, Cedars-Sinai Hospital and Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peyton L","family":"Nisson","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin A","family":"Peng","sequence":"additional","affiliation":[{"name":"Division of Neuro-otology, House Institute, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wouter I","family":"Schievink","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory P","family":"Lekovic","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, House Institute, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"7","key":"b1","series-title":"Neurology.","first-page":"673","article-title":"A classification system of spontaneous spinal CSF leaks","volume":"87","author":"Schievink WI","year":"2016","unstructured":"Schievink WI, Maya MM, Jean-Pierre S, Nu\u00f1o M, Prasad RS, Moser FG\n A classification system of spontaneous spinal CSF leaks. \nNeurology. 2016;87(7):673\u2013679."},{"issue":"6","key":"b2","series-title":"AJR Am J Roentgenol.","first-page":"1360","article-title":"CSF venous fistulas in spontaneous intracranial hypotension: imaging characteristics on dynamic and CT myelography","volume":"209","author":"Kranz PG","year":"2017","unstructured":"Kranz PG, Amrhein TJ, Gray L\n CSF venous fistulas in spontaneous intracranial hypotension: imaging characteristics on dynamic and CT myelography. AJR Am J Roentgenol. 2017;209(6):1360\u20131366."},{"issue":"4-5","key":"b3","series-title":"Cephalalgia.","first-page":"312","article-title":"Incidence of spontaneous intracranial hypotension in a community: Beverly Hills, California, 2006-2020","volume":"42","author":"Schievink WI","year":"2022","unstructured":"Schievink WI, Maya MM, Moser FG, Simon P, Nu\u00f1o M Incidence of spontaneous intracranial hypotension in a community: Beverly Hills, California, 2006-2020. Cephalalgia. 2022;42(4-5):312\u2013316."},{"issue":"4","key":"b4","series-title":"Cephalalgia.","first-page":"418","article-title":"Application of IHS criteria to headache attributed to spontaneous intracranial hypotension in a large population","volume":"29","author":"Mea E","year":"2009","unstructured":"Mea E, Chiapparini L, Savoiardo M, et\u00a0al. Application of IHS criteria to headache attributed to spontaneous intracranial hypotension in a large population. 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