{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:08:28Z","timestamp":1776096508847,"version":"3.50.1"},"reference-count":56,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"15","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"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":[[2026,4,13]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Cauda equina neuroendocrine tumor (CENET) is a rare spinal neuroendocrine tumor, and its coexistence with superficial siderosis (SS) is even more rare. CENETs are usually small and most commonly located below L2, and their imaging often overlaps with that of myxopapillary ependymomas or schwannomas, thus complicating their preoperative differentiation. The coexistence of SS and intratumoral fluid-fluid level (FFL) in CENET has not been documented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The authors describe a giant thoracolumbar CENET (T12\u2013L3) with intracranial SS in a patient with progressive paraparesis and bladder dysfunction. MRI revealed a hypervascular intradural extramedullary mass with an intratumoral FFL and neuraxial hemosiderin deposition, suggesting recurrent hemorrhage. Because of dense cauda equina adhesions, function-preserving subtotal resection was performed under intraoperative neurophysiological monitoring, resulting in marked neurological improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>In CENETs, the coexistence of SS, intratumoral FFL, and marked hypervascularity on preoperative imaging may indicate a chronic hemorrhagic phenotype with severe adhesions to the cauda equina, particularly in large multisegmental tumors. In such cases, nerve-sparing subtotal resection planned with preoperative vascular assessment and performed under intraoperative neurophysiological monitoring can be an appropriate strategy to balance tumor control with preservation of neurological function when safe dissection planes are limited.<\/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\/CASE251015\">https:\/\/thejns.org\/doi\/10.3171\/CASE251015<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case251015","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:27:35Z","timestamp":1776094055000},"source":"Crossref","is-referenced-by-count":0,"title":["Giant cauda equina neuroendocrine tumor with superficial siderosis: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Yaojing","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kakeru","family":"Abe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Hiu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirokazu","family":"Kurohama","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Pathology, Nagasaki University Hospital, Nagasak"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keishi","family":"Tsunoda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichi","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuhei","family":"Uotani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirofumi","family":"Koike","sequence":"additional","affiliation":[{"name":"Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8653-1553","authenticated-orcid":true,"given":"Masaomi","family":"Takeuchi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mai","family":"Shirahama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayaka","family":"Matsuo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7846-2393","authenticated-orcid":true,"given":"Daiki","family":"Uchida","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5562-9883","authenticated-orcid":true,"given":"Yuki","family":"Matsunaga","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiro","family":"Baba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3481-8508","authenticated-orcid":true,"given":"Kenta","family":"Ujifuku","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Nakashima","sequence":"additional","affiliation":[{"name":"Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takayuki","family":"Matsuo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"J Neurol Neurosurg Psychiatry","first-page":"100","article-title":"Paraganglioma of the cauda equina: a case report","volume":"50","author":"Anderson","year":"1987","unstructured":"Anderson JRGullan RW.Paraganglioma of the cauda equina: a case report. J Neurol Neurosurg Psychiatry. 1987;50(1):100-103. doi:10.1136\/jnnp.50.1.100"},{"issue":"4","key":"bib2","series-title":"Am J Surg Pathol","first-page":"469","article-title":"Cauda equina neuroendocrine tumors: distinct epithelial neuroendocrine neoplasms of spinal origin","volume":"47","author":"Asa","year":"2023","unstructured":"Asa SLMete OSch\u00fcller URamani BMirchia KPerry A.Cauda equina neuroendocrine tumors: distinct epithelial neuroendocrine neoplasms of spinal origin. Am J Surg Pathol. 2023;47(4):469-475. doi:10.1097\/PAS.0000000000002009"},{"issue":"8","key":"bib3","series-title":"Neuro Oncol","first-page":"1231","article-title":"The 2021 WHO Classification of Tumors of the Central Nervous System: a summary","volume":"23","author":"Louis","year":"2021","unstructured":"Louis DNPerry AWesseling PThe 2021 WHO Classification of Tumors of the Central Nervous System: a summary. 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J Neurosurg Spine. 2005;2(3):354-365. doi:10.3171\/spi.2005.2.3.0354"},{"key":"bib6","series-title":"World Neurosurg","first-page":"190","article-title":"Primary paraganglioma of the spine: a systematic review of clinical features and surgical management in cauda equina versus non-cauda equina lesions","volume":"161","author":"Palmisciano","year":"2022","unstructured":"Palmisciano PSagoo NSHaider ASPrimary paraganglioma of the spine: a systematic review of clinical features and surgical management in cauda equina versus non-cauda equina lesions. World Neurosurg. 2022;161:190-197.e20. doi:10.1016\/j.wneu.2022.01.110"},{"issue":"6","key":"bib7","series-title":"Ann Neurol","first-page":"1068","article-title":"Superficial siderosis: a clinical review","volume":"89","author":"Kumar","year":"2021","unstructured":"Kumar N.Superficial siderosis: a clinical review. Ann Neurol. 2021;89(6):1068-1079. doi:10.1002\/ana.26083"},{"issue":"4","key":"bib8","series-title":"Nagoya J Med Sci","first-page":"701","article-title":"Natural reduction in acute intratumoral hemorrhage of spinal schwannoma in the cauda equina","volume":"81","author":"Ito","year":"2019","unstructured":"Ito KAndo KKobayashi KNatural reduction in acute intratumoral hemorrhage of spinal schwannoma in the cauda equina. Nagoya J Med Sci. 2019;81(4):701-705. doi:10.18999\/nagjms.81.4.701"},{"issue":"2","key":"bib9","series-title":"Virchows Arch","first-page":"325","article-title":"Cauda equina neuroendocrine tumors show biological features distinct from other paragangliomas and visceral neuroendocrine tumors","volume":"482","author":"Soukup","year":"2023","unstructured":"Soukup JManethova MKohout ACauda equina neuroendocrine tumors show biological features distinct from other paragangliomas and visceral neuroendocrine tumors. Virchows Arch. 2023;482(2):325-338. doi:10.1007\/s00428-022-03441-1"},{"issue":"11","key":"bib10","series-title":"Cureus","first-page":"e48427","article-title":"Cauda equina neuroendocrine tumor: a histopathological case report","volume":"15","author":"Popov","year":"2023","unstructured":"Popov HPavlov PSStoyanov GS.Cauda equina neuroendocrine tumor: a histopathological case report. Cureus. 2023;15(11):e48427. doi:10.7759\/cureus.48427"},{"issue":"1","key":"bib11","series-title":"Neuroradiol J","first-page":"84","article-title":"Cauda equina neuroendocrine tumors: a single institutional imaging review of cases over two decades","volume":"37","author":"Ajmera","year":"2024","unstructured":"Ajmera PAgarwal AKMehta PMCauda equina neuroendocrine tumors: a single institutional imaging review of cases over two decades. 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Asian J Surg. 2024:S1015-9584(24)02020-7. doi:10.1016\/j.asjsur.2024.09.023"},{"issue":"1","key":"bib16","series-title":"J Neuroimaging","first-page":"54","article-title":"Giant paraganglioma of the cauda equina in adolescence: magnetic resonance imaging demonstration","volume":"6","author":"Wolansky","year":"1996","unstructured":"Wolansky LJStewart VAPramanik BKGiant paraganglioma of the cauda equina in adolescence: magnetic resonance imaging demonstration. J Neuroimaging. 1996;6(1):54-56. doi:10.1111\/jon19966154"},{"issue":"6","key":"bib17","series-title":"J Chin Med Assoc","first-page":"328","article-title":"Paraganglioma of the cauda equina presenting with erectile and sphincter dysfunction","volume":"72","author":"Marcol","year":"2009","unstructured":"Marcol WKiwic GMalinowska-Kolodziej IParaganglioma of the cauda equina presenting with erectile and sphincter dysfunction. J Chin Med Assoc. 2009;72(6):328-331. doi:10.1016\/S1726-4901(09)70380-6"},{"issue":"6","key":"bib18","series-title":"AJR Am J Roentgenol","first-page":"1650","article-title":"Calcified filum terminale paraganglioma causing superficial siderosis","volume":"170","author":"Sharma","year":"1998","unstructured":"Sharma AGaikwad SBGoyal MMishra NKSharma MC.Calcified filum terminale paraganglioma causing superficial siderosis. AJR Am J Roentgenol. 1998;170(6):1650-1652. doi:10.2214\/ajr.170.6.9609190"},{"issue":"6","key":"bib19","series-title":"Neurol India","first-page":"648","article-title":"Superficial siderosis in a patient with filum terminale paraganglioma","volume":"60","author":"Kinge","year":"2012","unstructured":"Kinge NGPaliwal VKNeyaz ZVerma R.Superficial siderosis in a patient with filum terminale paraganglioma. Neurol India. 2012;60(6):648-649. doi:10.4103\/0028-3886.105206"},{"key":"bib20","series-title":"J Clin Neurosci","first-page":"149","article-title":"Lumbar paraganglioma","volume":"30","author":"Dillard-Cannon","year":"2016","unstructured":"Dillard-Cannon EAtsina KBGhobrial GGnass ECurtis MTHeller J.Lumbar paraganglioma. J Clin Neurosci. 2016;30:149-151. doi:10.1016\/j.jocn.2016.01.019"},{"issue":"6","key":"bib21","series-title":"Acta Neurol Belg","first-page":"1471","article-title":"Radiologically atypical paraganglioma of the filum terminale as a rare cause of superficial siderosis of the central nervous system","volume":"120","author":"London","year":"2020","unstructured":"London FMulquin NFervaille CLebecque OJankovski A.Radiologically atypical paraganglioma of the filum terminale as a rare cause of superficial siderosis of the central nervous system. 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