{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:04Z","timestamp":1776096364266,"version":"3.50.1"},"reference-count":50,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"12","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"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":[[2026,3,23]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Spontaneous spinal CSF leaks can be difficult to diagnose, particularly with large or multiple dural tears. Although conventional CT myelography (CTM) is the standard imaging modality, it may fail to localize elusive leaks. Dynamic CTM (dCTM) enables real-time contrast tracking and improves localization, particularly for type 1 (ventral dural tear) and type 2 (lateral dural tear) leaks, to support targeted intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 36-year-old woman with Birt-Hogg-Dub\u00e9 syndrome and recurrent spontaneous CSF leaks previously treated with multiple epidural blood patches presented with worsening positional headaches. Brain MRI demonstrated features of intracranial hypotension, and total spine MRI raised concern for extradural fluid collection. Conventional CTM demonstrated a ventral extradural collection extending between T4 and T11 without a definitive source. Dynamic CTM successfully localized a ventral dural defect at T10\u201311. The patient underwent a posterior T10\u201311 laminectomy with dural reinforcement via a transpedicular approach using a TachoSil patch with DuraSeal. Her headaches resolved immediately, and she remained asymptomatic at the 6-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Dynamic CTM is a valuable tool for localizing ventral and lateral spinal CSF leaks when standard imaging is inconclusive. Early application of dCTM may reduce unnecessary interventions, shorten treatment delays, and optimize surgical planning.<\/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\/CASE25700\">https:\/\/thejns.org\/doi\/10.3171\/CASE25700<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25700","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:04:05Z","timestamp":1775642645000},"source":"Crossref","is-referenced-by-count":0,"title":["Targeted repair of a refractory ventral cerebrospinal fluid leak identified by dynamic computed tomography myelography: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Amelia","family":"Stepniak","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1258-8601","authenticated-orcid":true,"given":"Samuel","family":"Adida","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharath Kumar","family":"Anand","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vikas","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter C.","family":"Gerszten","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"4","key":"bib1","series-title":"Indian J Radiol Imaging","first-page":"441","article-title":"Imaging review of cerebrospinal fluid leaks","volume":"27","author":"Vemuri","year":"2017","unstructured":"Vemuri NVKaranam LSPManchikanti VDandamudi SPuvvada SKVemuri VK.Imaging review of cerebrospinal fluid leaks. 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Global Spine J. 2019;9(3):272-278. doi:10.1177\/2192568218791150"},{"issue":"8","key":"bib7","series-title":"AJNR Am J Neuroradiol","first-page":"1711","article-title":"Dynamic CT myelography: a technique for localizing high-flow spinal cerebrospinal fluid leaks","volume":"24","author":"Luetmer","year":"2003","unstructured":"Luetmer PHMokri B.Dynamic CT myelography: a technique for localizing high-flow spinal cerebrospinal fluid leaks. AJNR Am J Neuroradiol. 2003;24(8):1711-1714."},{"issue":"3","key":"bib8","series-title":"Clin Neuroradiol","first-page":"633","article-title":"Role of conventional dynamic myelography for detection of high-flow cerebrospinal fluid leaks: optimizing the technique","volume":"31","author":"Piechowiak","year":"2021","unstructured":"Piechowiak EIPospieszny KHaeni LRole of conventional dynamic myelography for detection of high-flow cerebrospinal fluid leaks: optimizing the technique. 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Radiol Clin North Am. 2024;62(2):311-319. doi:10.1016\/j.rcl.2023.09.002"},{"issue":"3","key":"bib16","series-title":"J Neurosurg Spine","first-page":"324","article-title":"Ultrafast dynamic computed tomography myelography for the precise identification of high-flow cerebrospinal fluid leaks caused by spiculated spinal osteophytes","volume":"22","author":"Thielen","year":"2015","unstructured":"Thielen KRSillery JCMorris JMUltrafast dynamic computed tomography myelography for the precise identification of high-flow cerebrospinal fluid leaks caused by spiculated spinal osteophytes. 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Br J Neurosurg. 2023;37(5):1406-1409. doi:10.1080\/02688697.2021.1881444"},{"issue":"6","key":"bib24","series-title":"Neurosurg Rev","first-page":"3779","article-title":"Collagen-bound fibrin sealant (TachoSil\u00ae) for dural closure in cranial surgery: single-centre comparative cohort study and systematic review of the literature","volume":"45","author":"Carretta","year":"2022","unstructured":"Carretta AEpskamp MLedermann LCollagen-bound fibrin sealant (TachoSil\u00ae) for dural closure in cranial surgery: single-centre comparative cohort study and systematic review of the literature. Neurosurg Rev. 2022;45(6):3779-3788. doi:10.1007\/s10143-022-01886-1"},{"issue":"4","key":"bib25","series-title":"PLoS One","first-page":"e0151533","article-title":"Fibrin sealants in dura sealing: a systematic literature review","volume":"11","author":"Esposito","year":"2016","unstructured":"Esposito FAngileri FFKruse PFibrin sealants in dura sealing: a systematic literature review. 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