{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:03:03Z","timestamp":1787025783525,"version":"build-2736575974"},"reference-count":68,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"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":[[2026,1,19]]},"abstract":"\n BACKGROUND<\/jats:title>\n Spinal hypertrophic pachymeningitis is a rare manifestation of immunoglobulin G4 (IgG4)\u2013related disease. This condition presents significant diagnostic and therapeutic challenges, and the literature on its surgical management remains limited.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 55-year-old woman with fibromyalgia and a 20-pack-year smoking history presented with 3 months of worsening back pain, lower extremity weakness, and numbness, corresponding to a modified Japanese Orthopaedic Association (mJOA) score of 10 at presentation. MRI revealed a mass-like epidural process spanning T1\u20135 with cord compression. Decompression was achieved with T1\u20135 laminectomies, during which dura mater thickening was observed and subsequently debulked. Pathology revealed findings consistent with possible IgG4 pachymeningitis. While the patient initially regained full strength in her lower extremities with surgery and medical management, she required a second surgery due to recurrent symptoms and renewed compression and dural thickening. She underwent a second dural debulking and decompression with duraplasty, which alleviated her recurrent symptoms. She remained free of recurrent symptoms at her 1-year postoperative follow-up, with an mJOA score of 17.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case demonstrates the effective use of a multidisciplinary team and recurrent surgical management, incorporating adjuncts such as intraoperative ultrasound and dural patch closure in the management of pachymeningitis causing significant cord compression, ultimately leading to lasting positive clinical improvement.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25313<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25313","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:00:05Z","timestamp":1769083205000},"source":"Crossref","is-referenced-by-count":1,"title":["Surgical management of recurrent spinal hypertrophic pachymeningitis: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Andr\u00e9s","family":"Pascual-Leone","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misha","family":"Amini","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan J.","family":"Winans","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina T.","family":"Yoh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2046-0560","authenticated-orcid":true,"given":"Eleonora F.","family":"Spinazzi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin A.","family":"Neira","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"bib1","series-title":"N Engl J Med","first-page":"539","article-title":"IgG4-related disease","volume":"366","author":"Stone","year":"2012","unstructured":"Stone JHZen YDeshpande V.IgG4-related disease. N Engl J Med. 2012;366(6):539-551."},{"key":"bib2","series-title":"IgG4-Related Disease","author":"Okazaki","year":"2017","unstructured":"Okazaki KIgG4-Related Disease. Springer; 2017."},{"issue":"3","key":"bib3","series-title":"Gut Liver","first-page":"300","article-title":"IgG4-related sclerosing cholangitis and primary sclerosing cholangitis","volume":"13","author":"Tanaka","year":"2019","unstructured":"Tanaka A.IgG4-related sclerosing cholangitis and primary sclerosing cholangitis. Gut Liver. 2019;13(3):300-307."},{"key":"bib4","series-title":"J Immunol Res","first-page":"6936727","article-title":"Salivary gland pathology in IgG4-related disease: a comprehensive review","volume":"2018","author":"Puxeddu","year":"2018","unstructured":"Puxeddu ICapecchi RCarta FTavoni AGMigliorini PPuxeddu R.Salivary gland pathology in IgG4-related disease: a comprehensive review. J Immunol Res. 2018;2018:6936727."},{"issue":"22","key":"bib5","series-title":"Med (Baltim)","first-page":"e10935","article-title":"IgG4-related fibrosing mediastinitis diagnosed with computed tomography-guided percutaneous needle biopsy: two case reports and a review of the literature","volume":"97","author":"Takanashi","year":"2018","unstructured":"Takanashi SAkiyama MSuzuki KOtomo KTakeuchi T.IgG4-related fibrosing mediastinitis diagnosed with computed tomography-guided percutaneous needle biopsy: two case reports and a review of the literature. Med (Baltim). 2018;97(22):e10935."},{"key":"bib6","series-title":"Int J Rheumatol","first-page":"572539","article-title":"IgG4-related lymphadenopathy","volume":"2012","author":"Sato","year":"2012","unstructured":"Sato YYoshino T.IgG4-related lymphadenopathy. Int J Rheumatol. 2012;2012:572539."},{"issue":"4","key":"bib7","series-title":"Neurol Neuroimmunol Neuroinflamm","first-page":"e568","article-title":"Immunoglobulin G4-related hypertrophic pachymeningitis: a case-oriented review","volume":"6","author":"Levraut","year":"2019","unstructured":"Levraut MCohen MBresch SImmunoglobulin G4-related hypertrophic pachymeningitis: a case-oriented review. Neurol Neuroimmunol Neuroinflamm. 2019;6(4):e568."},{"issue":"3","key":"bib8","series-title":"Mod Rheumatol","first-page":"529","article-title":"The 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD","volume":"31","author":"Umehara","year":"2021","unstructured":"Umehara HOkazaki KKawa SThe 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD. Mod Rheumatol. 2021;31(3):529-533."},{"issue":"9","key":"bib9","series-title":"Mod Pathol","first-page":"1181","article-title":"Consensus statement on the pathology of IgG4-related disease","volume":"25","author":"Deshpande","year":"2012","unstructured":"Deshpande VZen YChan JKConsensus statement on the pathology of IgG4-related disease. Mod Pathol. 2012;25(9):1181-1192."},{"issue":"6","key":"bib10","series-title":"Acta Neuropathol","first-page":"765","article-title":"IgG4-related meningeal disease: clinico-pathological features and proposal for diagnostic criteria","volume":"120","author":"Lindstrom","year":"2010","unstructured":"Lindstrom KMCousar JBLopes MBS.IgG4-related meningeal disease: clinico-pathological features and proposal for diagnostic criteria. 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BMC Neurol. 2024;24(1):318."},{"issue":"4","key":"bib13","series-title":"BJR Case Rep","first-page":"uaae022","article-title":"A case of IgG4-related disease manifesting as a spinal epidural mass","volume":"10","author":"Chau","year":"2024","unstructured":"Chau HHTLo BAChu WPHo HNTsui WMS.A case of IgG4-related disease manifesting as a spinal epidural mass. BJR Case Rep. 2024;10(4):uaae022."},{"key":"bib14","series-title":"Clin Neurol Neurosurg","first-page":"106342","article-title":"Neurosurgical and neuro-immunological management of IgG4-related hypertrophic sclerosing pachymeningitis. A literature survey and discussion of a unique index case","volume":"200","author":"Elmaci","year":"2021","unstructured":"Elmaci IAltinoz MAAkdemir GNeurosurgical and neuro-immunological management of IgG4-related hypertrophic sclerosing pachymeningitis. A literature survey and discussion of a unique index case. Clin Neurol Neurosurg. 2021;200:106342."},{"issue":"1","key":"bib15","series-title":"Neurol Res Pract","first-page":"43","article-title":"Intrathecal IgG4 synthesis in IgG4 related spinal hypertrophic pachymeningitis: a case report","volume":"6","author":"Feldmann","year":"2024","unstructured":"Feldmann LKvon Manitius RGrassmann BJIntrathecal IgG4 synthesis in IgG4 related spinal hypertrophic pachymeningitis: a case report. Neurol Res Pract. 2024;6(1):43."},{"key":"bib16","series-title":"Surg Neurol Int","first-page":"205","article-title":"Epiduritis related to IgG4 disease: a very rare cause for spinal cord compression","volume":"14","author":"Gader","year":"2023","unstructured":"Gader GAtig FBJemel NEpiduritis related to IgG4 disease: a very rare cause for spinal cord compression. Surg Neurol Int. 2023;14:205."},{"issue":"suppl 1","key":"bib17","series-title":"Eur Spine J","first-page":"147","article-title":"Cervicothoracic spinal cord compression caused by IgG4-related sclerosing pachymeningitis: a case report and literature review","volume":"25","author":"Gu","year":"2016","unstructured":"Gu RHao PYLiu JBWang ZHZhu QS.Cervicothoracic spinal cord compression caused by IgG4-related sclerosing pachymeningitis: a case report and literature review. Eur Spine J. 2016;25(suppl 1):147-151."},{"issue":"suppl 1","key":"bib18","series-title":"Eur Spine J","first-page":"75","article-title":"An inflammatory pseudotumor in the thoracic epidural space presenting with progressive paraplegia: a histopathological diagnosis with clinical and radiological uncertainty. Case report with literature review","volume":"25","author":"Kanagaraju","year":"2016","unstructured":"Kanagaraju VRai DAlluri RVCAn inflammatory pseudotumor in the thoracic epidural space presenting with progressive paraplegia: a histopathological diagnosis with clinical and radiological uncertainty. Case report with literature review. Eur Spine J. 2016;25(suppl 1):75-79."},{"issue":"3","key":"bib19","series-title":"Neurol India","first-page":"1223","article-title":"IgG4-related pachymeningitis as a cause of spinal epidural compression: can intraoperative frozen sections predict the underlying pathology?","volume":"70","author":"Karthigeyan","year":"2022","unstructured":"Karthigeyan MRajasekhar RSalunke PGupta K.IgG4-related pachymeningitis as a cause of spinal epidural compression: can intraoperative frozen sections predict the underlying pathology? Neurol India. 2022;70(3):1223-1225."},{"issue":"3","key":"bib20","series-title":"Neurol India","first-page":"1180","article-title":"Recurrent IgG4-related meningeal disease of the cervicothoracic spine: a case report and review of the literature","volume":"70","author":"Kramer","year":"2022","unstructured":"Kramer DEKerolus MGFurlan KNag SO\u2019Toole JE.Recurrent IgG4-related meningeal disease of the cervicothoracic spine: a case report and review of the literature. Neurol India. 2022;70(3):1180-1186."},{"key":"bib21","series-title":"J Neuroimmunol","first-page":"577325","article-title":"Immunoglobulin G4-related hypertrophic pachymeningitis with spinal cord compression: a case report","volume":"347","author":"Li","year":"2020","unstructured":"Li HXZuo LPeng XXImmunoglobulin G4-related hypertrophic pachymeningitis with spinal cord compression: a case report. J Neuroimmunol. 2020;347:577325."},{"issue":"6","key":"bib22","series-title":"Neurochirurgie","first-page":"e97","article-title":"Chiari decompression for syringomyelia in the setting of IgG4-related hypertrophic pachymeningitis: a case-based update","volume":"68","author":"Moskalik","year":"2022","unstructured":"Moskalik AKercher MVitt JLee HSWaldau B.Chiari decompression for syringomyelia in the setting of IgG4-related hypertrophic pachymeningitis: a case-based update. Neurochirurgie. 2022;68(6):e97-e100."},{"key":"bib23","series-title":"World Neurosurg","first-page":"264","article-title":"IgG4-related disease of the craniovertebral junction","volume":"134","author":"Park","year":"2020","unstructured":"Park BJStarks RKirby PMenezes AHDlouhy BJ.IgG4-related disease of the craniovertebral junction. World Neurosurg. 2020;134:264-271."},{"key":"bib24","series-title":"Brain Spine","first-page":"103325","article-title":"Cervical myelopathy caused by IgG4-related hypertrophic spinal pachymeningitis: case report and a descriptive review of the literature","volume":"4","author":"Parlak","year":"2024","unstructured":"Parlak AMueller CANolte KWCervical myelopathy caused by IgG4-related hypertrophic spinal pachymeningitis: case report and a descriptive review of the literature. Brain Spine. 2024;4:103325."},{"key":"bib25","series-title":"Front Neurol","first-page":"878414","article-title":"Immunoglobulin G4-related spinal intramedullary inflammatory pseudotumor: a Case report and literature review","volume":"13","author":"Qi","year":"2022","unstructured":"Qi ZLiu JLi GZhang Y.Immunoglobulin G4-related spinal intramedullary inflammatory pseudotumor: a Case report and literature review. 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Springer; 2017."},{"issue":"3","key":"bib3","series-title":"Gut Liver","first-page":"300","article-title":"IgG4-related sclerosing cholangitis and primary sclerosing cholangitis","volume":"13","author":"Tanaka","year":"2019","unstructured":"Tanaka A.IgG4-related sclerosing cholangitis and primary sclerosing cholangitis. Gut Liver. 2019;13(3):300-307."},{"key":"bib4","series-title":"J Immunol Res","first-page":"6936727","article-title":"Salivary gland pathology in IgG4-related disease: a comprehensive review","volume":"2018","author":"Puxeddu","year":"2018","unstructured":"Puxeddu ICapecchi RCarta FTavoni AGMigliorini PPuxeddu R.Salivary gland pathology in IgG4-related disease: a comprehensive review. J Immunol Res. 2018;2018:6936727."},{"issue":"22","key":"bib5","series-title":"Med (Baltim)","first-page":"e10935","article-title":"IgG4-related fibrosing mediastinitis diagnosed with computed tomography-guided percutaneous needle biopsy: two case reports and a review of the literature","volume":"97","author":"Takanashi","year":"2018","unstructured":"Takanashi SAkiyama MSuzuki KOtomo KTakeuchi T.IgG4-related fibrosing mediastinitis diagnosed with computed tomography-guided percutaneous needle biopsy: two case reports and a review of the literature. Med (Baltim). 2018;97(22):e10935."},{"key":"bib6","series-title":"Int J Rheumatol","first-page":"572539","article-title":"IgG4-related lymphadenopathy","volume":"2012","author":"Sato","year":"2012","unstructured":"Sato YYoshino T.IgG4-related lymphadenopathy. Int J Rheumatol. 2012;2012:572539."},{"issue":"4","key":"bib7","series-title":"Neurol Neuroimmunol Neuroinflamm","first-page":"e568","article-title":"Immunoglobulin G4-related hypertrophic pachymeningitis: a case-oriented review","volume":"6","author":"Levraut","year":"2019","unstructured":"Levraut MCohen MBresch SImmunoglobulin G4-related hypertrophic pachymeningitis: a case-oriented review. Neurol Neuroimmunol Neuroinflamm. 2019;6(4):e568."},{"issue":"3","key":"bib8","series-title":"Mod Rheumatol","first-page":"529","article-title":"The 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD","volume":"31","author":"Umehara","year":"2021","unstructured":"Umehara HOkazaki KKawa SThe 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD. Mod Rheumatol. 2021;31(3):529-533."},{"issue":"9","key":"bib9","series-title":"Mod Pathol","first-page":"1181","article-title":"Consensus statement on the pathology of IgG4-related disease","volume":"25","author":"Deshpande","year":"2012","unstructured":"Deshpande VZen YChan JKConsensus statement on the pathology of IgG4-related disease. Mod Pathol. 2012;25(9):1181-1192."},{"issue":"6","key":"bib10","series-title":"Acta Neuropathol","first-page":"765","article-title":"IgG4-related meningeal disease: clinico-pathological features and proposal for diagnostic criteria","volume":"120","author":"Lindstrom","year":"2010","unstructured":"Lindstrom KMCousar JBLopes MBS.IgG4-related meningeal disease: clinico-pathological features and proposal for diagnostic criteria. 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BMC Neurol. 2024;24(1):318."},{"issue":"4","key":"bib13","series-title":"BJR Case Rep","first-page":"uaae022","article-title":"A case of IgG4-related disease manifesting as a spinal epidural mass","volume":"10","author":"Chau","year":"2024","unstructured":"Chau HHTLo BAChu WPHo HNTsui WMS.A case of IgG4-related disease manifesting as a spinal epidural mass. BJR Case Rep. 2024;10(4):uaae022."},{"key":"bib14","series-title":"Clin Neurol Neurosurg","first-page":"106342","article-title":"Neurosurgical and neuro-immunological management of IgG4-related hypertrophic sclerosing pachymeningitis. A literature survey and discussion of a unique index case","volume":"200","author":"Elmaci","year":"2021","unstructured":"Elmaci IAltinoz MAAkdemir GNeurosurgical and neuro-immunological management of IgG4-related hypertrophic sclerosing pachymeningitis. A literature survey and discussion of a unique index case. 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Surg Neurol Int. 2023;14:205."},{"issue":"suppl 1","key":"bib17","series-title":"Eur Spine J","first-page":"147","article-title":"Cervicothoracic spinal cord compression caused by IgG4-related sclerosing pachymeningitis: a case report and literature review","volume":"25","author":"Gu","year":"2016","unstructured":"Gu RHao PYLiu JBWang ZHZhu QS.Cervicothoracic spinal cord compression caused by IgG4-related sclerosing pachymeningitis: a case report and literature review. Eur Spine J. 2016;25(suppl 1):147-151."},{"issue":"suppl 1","key":"bib18","series-title":"Eur Spine J","first-page":"75","article-title":"An inflammatory pseudotumor in the thoracic epidural space presenting with progressive paraplegia: a histopathological diagnosis with clinical and radiological uncertainty. 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