{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:32:10Z","timestamp":1769725930330,"version":"3.49.0"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"24","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"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":[[2025,12,15]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Radiation therapy is a common treatment for spinal metastases. However, its effects on extramedullary intrathecal structures are poorly understood. Arachnoid webs are rare structural abnormalities that can cause significant neurological symptoms due to spinal cord compression. While radiation-induced myelopathy is a rare known complication of radiation therapy, the potential relationship between radiation treatment and the formation or exacerbation of arachnoid webs has not been previously reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The authors present the case of a 64-year-old female with breast cancer and spinal osseous metastases who underwent palliative radiation therapy. Six months after radiation therapy, she developed progressive myelopathy refractory to conservative treatments. Imaging revealed dorsal cord indentation and edema with findings suggestive of a compressive arachnoid web. Surgical intervention confirmed an extensive complex arachnoid web spanning T5\u20138. Fenestration of the web resulted in immediate intraoperative improvement in somatosensory evoked potentials and significant postoperative neurological recovery over 8 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case highlights the importance of considering structural abnormalities, such as arachnoid webs, in patients with progressive myelopathy following spinal radiation therapy, even when doses are within safe limits. Myelography may be helpful for characterizing intrathecal changes in this context. Further research is needed to explore the relationship between radiation therapy and arachnoid pathology.<\/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\/CASE25733\">https:\/\/thejns.org\/doi\/10.3171\/CASE25733<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25733","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T11:59:56Z","timestamp":1769083196000},"source":"Crossref","is-referenced-by-count":0,"title":["Thoracic spinal cord myelopathy from complex arachnoid web formation\/exacerbation after palliative radiation therapy for spinal metastasis: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"given":"Raven D.","family":"Spencer","sequence":"first","affiliation":[{"name":"Department of Radiology, Allegheny Health Network, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clementina N.","family":"Aiyudu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7427-5547","authenticated-orcid":true,"given":"Lara W.","family":"Massie","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bindu V.","family":"Rusia","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2559-1535","authenticated-orcid":true,"given":"Charles Q.","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiology, Allegheny Health Network, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"7","key":"bib1","series-title":"Cureus","first-page":"e41362","article-title":"Radiation myelopathy: a case report and literature review","volume":"15","author":"Iftekharuddin","year":"2023","unstructured":"Iftekharuddin AGospodarev VHussain NS.Radiation myelopathy: a case report and literature review. Cureus. 2023;15(7):e41362."},{"issue":"8","key":"bib2","series-title":"Spinal Cord","first-page":"574","article-title":"Pathobiology of radiation myelopathy and strategies to mitigate injury","volume":"53","author":"Wong","year":"2015","unstructured":"Wong CSFehlings MGSahgal A.Pathobiology of radiation myelopathy and strategies to mitigate injury. Spinal Cord. 2015;53(8):574-580."},{"issue":"4","key":"bib3","series-title":"Asian J Neurosurg","first-page":"206","article-title":"Delayed radiation myelopathy: differential diagnosis with positron emission tomography\/computed tomography examination","volume":"7","author":"Kadir","year":"2012","unstructured":"Kadir TSarica FBOzgur KCekinmez MNur AM.Delayed radiation myelopathy: differential diagnosis with positron emission tomography\/computed tomography examination. Asian J Neurosurg. 2012;7(4):206-209."},{"issue":"4","key":"bib4","series-title":"Neuropathology","first-page":"247","article-title":"Pathology of radiation myelopathy","volume":"21","author":"Okada","year":"2001","unstructured":"Okada SOkeda R.Pathology of radiation myelopathy. Neuropathology. 2001;21(4):247-265."},{"issue":"5","key":"bib5","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1093","article-title":"Radiation response of the central nervous system","volume":"31","author":"Schultheiss","year":"1995","unstructured":"Schultheiss TEKun LEAng KKStephens LC.Radiation response of the central nervous system. Int J Radiat Oncol Biol Phys. 1995;31(5):1093-1112."},{"issue":"4","key":"bib6","series-title":"Radiat Oncol Investig","first-page":"193","article-title":"Radiation myelopathy: new perspective on an old problem","volume":"7","author":"Nieder","year":"1999","unstructured":"Nieder CAtaman FPrice REAng KK.Radiation myelopathy: new perspective on an old problem. Radiat Oncol Investig. 1999;7(4):193-203."},{"issue":"3","key":"bib7","series-title":"Int J Radiat Oncol Biol Phys","first-page":"735","article-title":"Spinal cord radiation tolerance","volume":"30","author":"Schultheiss","year":"1994","unstructured":"Schultheiss TE.Spinal cord radiation tolerance. Int J Radiat Oncol Biol Phys. 1994;30(3):735-736."},{"issue":"4","key":"bib8","series-title":"Neurosciences (Riyadh)","first-page":"392","article-title":"A brief case series of radiation associated myelopathy","volume":"26","author":"B\u00fcn\u00fcl","year":"2021","unstructured":"B\u00fcn\u00fcl SDSar\u0131kaya CE\u00d6zt\u00fcrk OSar\u0131kaya C.A brief case series of radiation associated myelopathy. Neurosciences (Riyadh). 2021;26(4):392-395."},{"issue":"2","key":"bib9","series-title":"J Spine Surg","first-page":"446","article-title":"Spinal arachnoid web\u2014a review article","volume":"4","author":"Ben Ali","year":"2018","unstructured":"Ben Ali HHamilton PZygmunt SYakoub KM.Spinal arachnoid web\u2014a review article. J Spine Surg. 2018;4(2):446-450."},{"issue":"3","key":"bib10","series-title":"J Neuropathol Exp Neurol","first-page":"484","article-title":"Cerebral arachnoid cysts","volume":"17","author":"Starkman","year":"1958","unstructured":"Starkman SPBrown TCLinell EA.Cerebral arachnoid cysts. J Neuropathol Exp Neurol. 1958;17(3):484-500."},{"key":"bib11","series-title":"Clinical Radiation Oncology","first-page":"521","article-title":"Spinal cord tumors","author":"Siker","year":"2016","unstructured":"Siker MLBovi JAlexander B.Spinal cord tumors. In: Clinical Radiation Oncology. 5th ed. Elsevier; 2016:521-540.e5."},{"issue":"11","key":"bib12","series-title":"Am J Health Syst Pharm","first-page":"999","article-title":"Understanding and managing the possible adverse effects associated with bevacizumab","volume":"66","author":"Shord","year":"2009","unstructured":"Shord SSBressler LRTierney LACuellar SGeorge A.Understanding and managing the possible adverse effects associated with bevacizumab. Am J Health Syst Pharm. 2009;66(11):999-1013."},{"issue":"7","key":"bib1","series-title":"Cureus","first-page":"e41362","article-title":"Radiation myelopathy: a case report and literature review","volume":"15","author":"Iftekharuddin","year":"2023","unstructured":"Iftekharuddin AGospodarev VHussain NS.Radiation myelopathy: a case report and literature review. Cureus. 2023;15(7):e41362."},{"issue":"8","key":"bib2","series-title":"Spinal Cord","first-page":"574","article-title":"Pathobiology of radiation myelopathy and strategies to mitigate injury","volume":"53","author":"Wong","year":"2015","unstructured":"Wong CSFehlings MGSahgal A.Pathobiology of radiation myelopathy and strategies to mitigate injury. Spinal Cord. 2015;53(8):574-580."},{"issue":"4","key":"bib3","series-title":"Asian J Neurosurg","first-page":"206","article-title":"Delayed radiation myelopathy: differential diagnosis with positron emission tomography\/computed tomography examination","volume":"7","author":"Kadir","year":"2012","unstructured":"Kadir TSarica FBOzgur KCekinmez MNur AM.Delayed radiation myelopathy: differential diagnosis with positron emission tomography\/computed tomography examination. Asian J Neurosurg. 2012;7(4):206-209."},{"issue":"4","key":"bib4","series-title":"Neuropathology","first-page":"247","article-title":"Pathology of radiation myelopathy","volume":"21","author":"Okada","year":"2001","unstructured":"Okada SOkeda R.Pathology of radiation myelopathy. Neuropathology. 2001;21(4):247-265."},{"issue":"5","key":"bib5","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1093","article-title":"Radiation response of the central nervous system","volume":"31","author":"Schultheiss","year":"1995","unstructured":"Schultheiss TEKun LEAng KKStephens LC.Radiation response of the central nervous system. Int J Radiat Oncol Biol Phys. 1995;31(5):1093-1112."},{"issue":"4","key":"bib6","series-title":"Radiat Oncol Investig","first-page":"193","article-title":"Radiation myelopathy: new perspective on an old problem","volume":"7","author":"Nieder","year":"1999","unstructured":"Nieder CAtaman FPrice REAng KK.Radiation myelopathy: new perspective on an old problem. Radiat Oncol Investig. 1999;7(4):193-203."},{"issue":"3","key":"bib7","series-title":"Int J Radiat Oncol Biol Phys","first-page":"735","article-title":"Spinal cord radiation tolerance","volume":"30","author":"Schultheiss","year":"1994","unstructured":"Schultheiss TE.Spinal cord radiation tolerance. Int J Radiat Oncol Biol Phys. 1994;30(3):735-736."},{"issue":"4","key":"bib8","series-title":"Neurosciences (Riyadh)","first-page":"392","article-title":"A brief case series of radiation associated myelopathy","volume":"26","author":"B\u00fcn\u00fcl","year":"2021","unstructured":"B\u00fcn\u00fcl SDSar\u0131kaya CE\u00d6zt\u00fcrk OSar\u0131kaya C.A brief case series of radiation associated myelopathy. Neurosciences (Riyadh). 2021;26(4):392-395."},{"issue":"2","key":"bib9","series-title":"J Spine Surg","first-page":"446","article-title":"Spinal arachnoid web\u2014a review article","volume":"4","author":"Ben Ali","year":"2018","unstructured":"Ben Ali HHamilton PZygmunt SYakoub KM.Spinal arachnoid web\u2014a review article. J Spine Surg. 2018;4(2):446-450."},{"issue":"3","key":"bib10","series-title":"J Neuropathol Exp Neurol","first-page":"484","article-title":"Cerebral arachnoid cysts","volume":"17","author":"Starkman","year":"1958","unstructured":"Starkman SPBrown TCLinell EA.Cerebral arachnoid cysts. J Neuropathol Exp Neurol. 1958;17(3):484-500."},{"key":"bib11","series-title":"Clinical Radiation Oncology","first-page":"521","article-title":"Spinal cord tumors","author":"Siker","year":"2016","unstructured":"Siker MLBovi JAlexander B.Spinal cord tumors. In: Clinical Radiation Oncology. 5th ed. Elsevier; 2016:521-540.e5."},{"issue":"11","key":"bib12","series-title":"Am J Health Syst Pharm","first-page":"999","article-title":"Understanding and managing the possible adverse effects associated with bevacizumab","volume":"66","author":"Shord","year":"2009","unstructured":"Shord SSBressler LRTierney LACuellar SGeorge A.Understanding and managing the possible adverse effects associated with bevacizumab. 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