{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:07Z","timestamp":1776096367440,"version":"3.50.1"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"11","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"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":[[2026,3,16]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Spontaneous intracranial hypotension (SIH) caused by a CSF leak due to a subtle dural defect often leads to debilitating orthostatic headaches and subdural fluid collection. Various surgical techniques have been described for iatrogenic leaks but not for spontaneous cervical nerve root leaks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 35-year-old female presented with progressive neck pain, severe orthostatic headaches, and bilateral subdural fluid collection. Imaging revealed a type 1b ventral dural tear at the right C8 nerve root. A posterior cervical approach exposing the nerve roots located the subtle leak site. A team consisting of neurosurgeons and a head and neck reconstructive surgeon harvested and positioned a paraspinal musculature flap, fashioned into two leaflets, to envelop the nerve roots ventrally and dorsally. Fibrin sealant and muscle plugs reinforced the closure. Postoperatively, the patient experienced rapid resolution of orthostatic headaches. At 6 months, she reported only mild, intermittent neck tightness without headache recurrence or evidence of CSF leakage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>A multidisciplinary surgical approach utilizing a chimeric rotational paraspinal flap to repair a spontaneous cervical CSF leak at the right C8 nerve root provided robust, vascularized coverage with resolution of SIH signs and symptoms. This flap-based technique offers a durable solution for challenging CSF leaks.<\/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\/CASE25698\">https:\/\/thejns.org\/doi\/10.3171\/CASE25698<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25698","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:13:03Z","timestamp":1773925983000},"source":"Crossref","is-referenced-by-count":0,"title":["Intracranial hypotension secondary to a spontaneous cervical nerve root leak repaired using a chimeric rotational paraspinal flap: a multidisciplinary surgical approach. Illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8183-344X","authenticated-orcid":true,"given":"Russel T.","family":"Wagner","sequence":"first","affiliation":[{"name":"Intent Medical Group, Endeavor Health Advanced Neurosciences Center, Northwest Community Hospital, Arlington Heights, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah L.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Intent Medical Group, Endeavor Health Advanced Neurosciences Center, Northwest Community Hospital, Arlington Heights, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacopo","family":"Berardinelli","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Napoli, Campania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melanie","family":"Fukui","sequence":"additional","affiliation":[{"name":"Intent Medical Group, Endeavor Health Advanced Neurosciences Center, Northwest Community Hospital, Arlington Heights, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9328-8266","authenticated-orcid":true,"given":"Neil S.","family":"Mundi","sequence":"additional","affiliation":[{"name":"Intent Medical Group, Endeavor Health Advanced Neurosciences Center, Northwest Community Hospital, Arlington Heights, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amin B.","family":"Kassam","sequence":"additional","affiliation":[{"name":"Intent Medical Group, Endeavor Health Advanced Neurosciences Center, Northwest Community Hospital, Arlington Heights, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Russ P.","family":"Nockels","sequence":"additional","affiliation":[{"name":"Intent Medical Group, Endeavor Health Advanced Neurosciences Center, Northwest Community Hospital, Arlington Heights, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"StatPearls","article-title":"Spontaneous intracranial hypotentsion","author":"Liaquat","year":"2025","unstructured":"Liaquat MTJain S.Spontaneous intracranial hypotentsion. In: StatPearls. StatPearls Publishing; 2025. Accessed February 17, 2026. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK559066\/"},{"issue":"1","key":"bib2","series-title":"Neurosurgery","first-page":"65","article-title":"Connective tissue disorders with spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension: a prospective study","volume":"54","author":"Schievink","year":"2004","unstructured":"Schievink WIGordon OKTourje J.Connective tissue disorders with spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension: a prospective study. Neurosurgery. 2004;54(1):65-70. doi:10.1227\/01.neu.0000097200.18478.7b"},{"issue":"1","key":"bib3","series-title":"Curr Probl Diagn Radiol","first-page":"10","article-title":"\u201cThe up and down approach\u201d to localize and exclude sites of intraspinal CSF leaks","volume":"52","author":"Gerasymchuk","year":"2023","unstructured":"Gerasymchuk MLabak CHoffer SNayate AP.\u201cThe up and down approach\u201d to localize and exclude sites of intraspinal CSF leaks. Curr Probl Diagn Radiol. 2023;52(1):10-13. doi:10.1067\/j.cpradiol.2022.08.002"},{"issue":"7","key":"bib4","series-title":"Neurology","first-page":"673","article-title":"A classification system of spontaneous spinal CSF leaks","volume":"87","author":"Schievink","year":"2016","unstructured":"Schievink WIMaya MMJean-Pierre SNu\u00f1o MPrasad RSMoser FG.A classification system of spontaneous spinal CSF leaks. Neurology. 2016;87(7):673-679. doi:10.1212\/WNL.0000000000002986"},{"issue":"1","key":"bib5","series-title":"Acta Neurol Belg","first-page":"9","article-title":"Spontaneous intracranial hypotension: review and expert opinion","volume":"120","author":"Ferrante","year":"2020","unstructured":"Ferrante ETrimboli MRubino F.Spontaneous intracranial hypotension: review and expert opinion. Acta Neurol Belg. 2020;120(1):9-18. doi:10.1007\/s13760-019-01166-8"},{"issue":"7","key":"bib6","series-title":"Headache","first-page":"1034","article-title":"Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks","volume":"53","author":"Mokri","year":"2013","unstructured":"Mokri B.Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks. Headache. 2013;53(7):1034-1053. doi:10.1111\/head.12149"},{"issue":"19","key":"bib7","series-title":"JAMA","first-page":"2286","article-title":"Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension","volume":"295","author":"Schievink","year":"2006","unstructured":"Schievink WI.Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA. 2006;295(19):2286-2296. doi:10.1001\/jama.295.19.2286"},{"issue":"5","key":"bib8","series-title":"Plast Reconstr Surg","first-page":"642e","article-title":"Muscle flap closure following complex spine surgery: a decade of experience","volume":"146","author":"Wright","year":"2020","unstructured":"Wright MAWeinstein ALBernstein JLMuscle flap closure following complex spine surgery: a decade of experience. Plast Reconstr Surg. 2020;146(5):642e-650e. doi:10.1097\/prs.0000000000007274"},{"key":"bib9","series-title":"World Neurosurg","first-page":"267","article-title":"Pedicled multifidus muscle flap to treat inaccessible dural tear in spine surgery: technical note and preliminary experience","volume":"145","author":"Policicchio","year":"2021","unstructured":"Policicchio DBoccaletti RDipellegrini GDoda AStangoni AVeneziani SF.Pedicled multifidus muscle flap to treat inaccessible dural tear in spine surgery: technical note and preliminary experience. 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J Plast Reconstr Aesthet Surg. 2023;87:83-90. doi:10.1016\/j.bjps.2023.09.039"},{"key":"bib1","series-title":"StatPearls","article-title":"Spontaneous intracranial hypotentsion","author":"Liaquat","year":"2025","unstructured":"Liaquat MTJain S.Spontaneous intracranial hypotentsion. In: StatPearls. StatPearls Publishing; 2025. Accessed February 17, 2026. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK559066\/"},{"issue":"1","key":"bib2","series-title":"Neurosurgery","first-page":"65","article-title":"Connective tissue disorders with spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension: a prospective study","volume":"54","author":"Schievink","year":"2004","unstructured":"Schievink WIGordon OKTourje J.Connective tissue disorders with spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension: a prospective study. 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Neurology. 2016;87(7):673-679. doi:10.1212\/WNL.0000000000002986"},{"issue":"1","key":"bib5","series-title":"Acta Neurol Belg","first-page":"9","article-title":"Spontaneous intracranial hypotension: review and expert opinion","volume":"120","author":"Ferrante","year":"2020","unstructured":"Ferrante ETrimboli MRubino F.Spontaneous intracranial hypotension: review and expert opinion. Acta Neurol Belg. 2020;120(1):9-18. doi:10.1007\/s13760-019-01166-8"},{"issue":"7","key":"bib6","series-title":"Headache","first-page":"1034","article-title":"Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks","volume":"53","author":"Mokri","year":"2013","unstructured":"Mokri B.Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks. Headache. 2013;53(7):1034-1053. doi:10.1111\/head.12149"},{"issue":"19","key":"bib7","series-title":"JAMA","first-page":"2286","article-title":"Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension","volume":"295","author":"Schievink","year":"2006","unstructured":"Schievink WI.Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA. 2006;295(19):2286-2296. doi:10.1001\/jama.295.19.2286"},{"issue":"5","key":"bib8","series-title":"Plast Reconstr Surg","first-page":"642e","article-title":"Muscle flap closure following complex spine surgery: a decade of experience","volume":"146","author":"Wright","year":"2020","unstructured":"Wright MAWeinstein ALBernstein JLMuscle flap closure following complex spine surgery: a decade of experience. 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