{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:27:12Z","timestamp":1769725632154,"version":"3.49.0"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","license":[{"start":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T00:00:00Z","timestamp":1752451200000},"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 Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,7,14]]},"abstract":"\n BACKGROUND<\/jats:title>\n Diffuse midline glioma (DMG) H3K27-altered is a newly recognized diffuse high-grade tumor entity in the 5th edition of the WHO classification of CNS tumors. Spinal extradural metastasis is extremely rare in patients with DMG H3K27-altered, while the occurrence of spinal intramedullary DMG, intradural dissemination, and osseous metastasis has been reported.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors report the case of a 6-year-old female presenting with acute-onset urinary retention and paraplegia, who was found to have a pontine DMG, an intradural mass at the level of T1\u20136, and an extradural lesion at T6\u20139. The thecal sac was severely compressed by the extradural mass; thus, a T6\u20139 laminectomy and extradural tumor resection were performed. After the procedure, an amelioration of weakness was observed. The patient was treated with radiotherapy to the spine. Pathology revealed an increase in chromatin, the proliferation of atypical cells, and microvascular proliferation. The H3K27 mutation was confirmed.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case demonstrates an operative view in the metastasis of DMG H3K27-altered to the spinal epidural space without visceral or osseous metastasis. The possibility of spinal epidural metastasis and its surgical treatability should be considered if patients with DMG present spinal cord symptoms.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25249<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25249","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T06:25:40Z","timestamp":1752474340000},"source":"Crossref","is-referenced-by-count":1,"title":["Diffuse midline glioma H3K27-altered with thoracic epidural metastasis: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"given":"Kan","family":"Sumita","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3178-4552","authenticated-orcid":true,"given":"Masahiro","family":"Sawada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2975-774X","authenticated-orcid":true,"given":"Etsuko Yamamoto","family":"Hattori","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8999-1976","authenticated-orcid":true,"given":"Noritaka","family":"Sano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2977-888X","authenticated-orcid":true,"given":"Shigeki","family":"Takada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Tanji","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yohei","family":"Mineharu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan"},{"name":"Department of Artificial Intelligence in Healthcare and Medicine, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6295-5510","authenticated-orcid":true,"given":"Takayuki","family":"Kikuchi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4626-4645","authenticated-orcid":true,"given":"Yoshiki","family":"Arakawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"8","key":"bib1","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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Acta Neuropathol. 2014;128(4):573-581."},{"issue":"16","key":"bib4","series-title":"J Neurosurg Case Lessons","first-page":"CASE22529","article-title":"Diffuse midline glioma, H3K27-altered, of the conus medullaris presenting as acute urinary retention: illustrative case","volume":"5","author":"Saluja","year":"2023","unstructured":"Saluja SRazzaq BServider JASeidman RMushlin H.Diffuse midline glioma, H3K27-altered, of the conus medullaris presenting as acute urinary retention: illustrative case. J Neurosurg Case Lessons. 2023;5(16):CASE22529."},{"issue":"1","key":"bib5","series-title":"BMC Neurol","first-page":"87","article-title":"A rare case of H3K27-altered diffuse midline glioma with multiple osseous and spinal metastases at the time of diagnosis","volume":"23","author":"Aftahy","year":"2023","unstructured":"Aftahy AKButenschoen VMHoenikl LA rare case of H3K27-altered diffuse midline glioma with multiple osseous and spinal metastases at the time of diagnosis. 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Front Mol Neurosci. 2023;16:1152430."},{"issue":"7","key":"bib8","series-title":"J Pediatr Hematol Oncol","first-page":"e673","article-title":"Diffuse midline glioma with osseous metastases at diagnosis: a case report","volume":"42","author":"Bhatt","year":"2020","unstructured":"Bhatt NSHouser KBelongia MDiffuse midline glioma with osseous metastases at diagnosis: a case report. J Pediatr Hematol Oncol. 2020;42(7):e673-e676."},{"issue":"12","key":"bib9","series-title":"Childs Nerv Syst","first-page":"3933","article-title":"Spinal intramedullary H3K27M mutant glioma with vertebral metastasis: a case report","volume":"37","author":"Handis","year":"2021","unstructured":"Handis CTanr\u0131kulu BDanyeli AE\u00d6zek MM.Spinal intramedullary H3K27M mutant glioma with vertebral metastasis: a case report. 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