{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:07:45Z","timestamp":1776096465597,"version":"3.50.1"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"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":[[2026,1,26]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Retro-odontoid pseudotumors are soft tissue lesions behind the odontoid process, commonly associated with chronic atlantoaxial instability from rheumatoid arthritis, Down syndrome, and untreated injuries. Surgical techniques have evolved to address these histologically benign lesions when their mass effect causes cervical myelopathy. Historically, these were treated by direct spinal cord decompression via a transoral odontoidectomy. It is now understood that most retro-odontoid pseudotumors will regress with atlantoaxial fixation and fusion. Although uncommon, cystic masses can be associated with retro-odontoid pseudotumors and can create a secondary space-occupying lesion contributing to further cord compromise. Such cysts have been described in the extradural compartment. More uncommonly, they can erode through the ventral dura mater.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 63-year-old female with prior C4\u20137 anterior cervical discectomy and fusion presented with worsening gait instability and myelopathy. MRI confirmed a retro-odontoid pannus with an adjacent left-sided cyst causing severe spinal cord compression. Intraoperatively, the cyst was discovered to be extradural and adhered to the ventral dura, prompting a transdural approach for resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>A paucity of literature exists regarding the management of symptomatic retro-odontoid cysts. This report demonstrates key steps of a transdural approach for the resection of a large retro-odontoid cyst with strong adherence to the ventral dura, accompanied by an intraoperative video and graphical illustrations.<\/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\/CASE25757\">https:\/\/thejns.org\/doi\/10.3171\/CASE25757<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25757","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T06:29:07Z","timestamp":1769408947000},"source":"Crossref","is-referenced-by-count":0,"title":["Technical nuances of a posterior transdural approach for resection of a compressive retro-odontoid cyst with 2D operative video and graphical illustration: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Taylor N.","family":"Murray","sequence":"first","affiliation":[{"name":"School of Medicine, University of North Carolina at Chapel Hill, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9313-2814","authenticated-orcid":true,"given":"Veda","family":"Dayananda","sequence":"additional","affiliation":[{"name":"Brown University, Providence, Rhode Island"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1767-2052","authenticated-orcid":true,"given":"Zoe","family":"Robinow","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of North Carolina Hospitals, Chapel Hill, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Galgano","sequence":"additional","affiliation":[{"name":"School of Medicine, University of North Carolina at Chapel Hill, North Carolina"},{"name":"Department of Neurosurgery, University of North Carolina Hospitals, Chapel Hill, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"Neurospine","first-page":"67","article-title":"Retro-odontoid pseudotumor formation in the context of various acquired and congenital pathologies of the craniovertebral junction and surgical techniques","volume":"18","author":"Fiani","year":"2021","unstructured":"Fiani BHouston RSiddiqi IRetro-odontoid pseudotumor formation in the context of various acquired and congenital pathologies of the craniovertebral junction and surgical techniques. Neurospine. 2021;18(1):67-78."},{"issue":"1","key":"bib2","series-title":"Neurospine","first-page":"177","article-title":"Nonrheumatoid retro-odontoid pseudotumors: characteristics, surgical outcomes, and time-dependent regression after posterior fixation","volume":"18","author":"Niwa","year":"2021","unstructured":"Niwa RTakai KTaniguchi M.Nonrheumatoid retro-odontoid pseudotumors: characteristics, surgical outcomes, and time-dependent regression after posterior fixation. Neurospine. 2021;18(1):177-187."},{"issue":"6","key":"bib3","series-title":"Indian J Orthop","first-page":"621","article-title":"Retro-odontoid cystic mass treated by laminectomy and C1-C2 fixation","volume":"48","author":"Lin","year":"2014","unstructured":"Lin DDing ZGuo YLian K.Retro-odontoid cystic mass treated by laminectomy and C1-C2 fixation. Indian J Orthop. 2014;48(6):621-624."},{"issue":"3","key":"bib4","series-title":"J Neurosurg Spine","first-page":"236","article-title":"Transdural approach to resection of retro-odontoid cysts in elderly patients: report of 3 cases","volume":"28","author":"Madhavan","year":"2018","unstructured":"Madhavan KChieng LOGaynor BGLevi AD.Transdural approach to resection of retro-odontoid cysts in elderly patients: report of 3 cases. J Neurosurg Spine. 2018;28(3):236-243."},{"issue":"suppl 2","key":"bib5","series-title":"Eur Spine J","first-page":"162","article-title":"The posterior cervical transdural approach for retro-odontoid mass pseudotumor resection: report of three cases and discussion of the current literature","volume":"29","author":"Schomacher","year":"2020","unstructured":"Schomacher MJiang FAlrjoub MWitiw CDDiamandis PFehlings MG.The posterior cervical transdural approach for retro-odontoid mass pseudotumor resection: report of three cases and discussion of the current literature. Eur Spine J. 2020;29(suppl 2):162-170."},{"issue":"3","key":"bib6","series-title":"Neurosurgery","first-page":"615","article-title":"Transdural approach for resection of craniovertebral junction cysts: case series","volume":"92","author":"Jamshidi","year":"2023","unstructured":"Jamshidi AMGovindarajan VLevi AD.Transdural approach for resection of craniovertebral junction cysts: case series. Neurosurgery. 2023;92(3):615-622."},{"issue":"1","key":"bib11","series-title":"Cureus","first-page":"e21715","article-title":"ntradural synovial cyst decompression via endoscopic-assisted far-lateral approach C1-C2 hemilaminectomy without fusion: the use of intracranial denticulate ligament as intraoperative landmark","volume":"14","author":"Fana","year":"2022","unstructured":"Fana MDeamont CMedani Kntradural synovial cyst decompression via endoscopic-assisted far-lateral approach C1-C2 hemilaminectomy without fusion: the use of intracranial denticulate ligament as intraoperative landmark. Cureus. 2022;14(1):e21715."},{"issue":"4","key":"bib7","series-title":"Ann Surg","first-page":"529","article-title":"X. Unilateral laminectomy","volume":"51","author":"Taylor","year":"1910","unstructured":"Taylor AS.X. Unilateral laminectomy. Ann Surg. 1910;51(4):529-533."},{"issue":"7","key":"bib8","series-title":"Spine (Phila Pa 1976)","first-page":"715","article-title":"Microsurgical transdural discectomy with laminoplasty: new treatment for paracentral and paracentroforaminal cervical disc herniation associated with spinal canal stenosis","volume":"27","author":"Fujimoto","year":"2002","unstructured":"Fujimoto YBaba ISumida TTanaka NOka SKawagoe H.Microsurgical transdural discectomy with laminoplasty: new treatment for paracentral and paracentroforaminal cervical disc herniation associated with spinal canal stenosis. 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Neurosurgery. 2023;92(3):615-622."},{"issue":"1","key":"bib11","series-title":"Cureus","first-page":"e21715","article-title":"ntradural synovial cyst decompression via endoscopic-assisted far-lateral approach C1-C2 hemilaminectomy without fusion: the use of intracranial denticulate ligament as intraoperative landmark","volume":"14","author":"Fana","year":"2022","unstructured":"Fana MDeamont CMedani Kntradural synovial cyst decompression via endoscopic-assisted far-lateral approach C1-C2 hemilaminectomy without fusion: the use of intracranial denticulate ligament as intraoperative landmark. Cureus. 2022;14(1):e21715."},{"issue":"4","key":"bib7","series-title":"Ann Surg","first-page":"529","article-title":"X. Unilateral laminectomy","volume":"51","author":"Taylor","year":"1910","unstructured":"Taylor AS.X. Unilateral laminectomy. Ann Surg. 1910;51(4):529-533."},{"issue":"7","key":"bib8","series-title":"Spine (Phila Pa 1976)","first-page":"715","article-title":"Microsurgical transdural discectomy with laminoplasty: new treatment for paracentral and paracentroforaminal cervical disc herniation associated with spinal canal stenosis","volume":"27","author":"Fujimoto","year":"2002","unstructured":"Fujimoto YBaba ISumida TTanaka NOka SKawagoe H.Microsurgical transdural discectomy with laminoplasty: new treatment for paracentral and paracentroforaminal cervical disc herniation associated with spinal canal stenosis. Spine (Phila Pa 1976). 2002;27(7):715-721."},{"issue":"10","key":"bib9","series-title":"J Spinal Disord Tech","first-page":"363","article-title":"Microscopic posterior transdural resection of cervical retro-odontoid pseudotumors","volume":"28","author":"Fujiwara","year":"2015","unstructured":"Fujiwara YManabe HSumida TTanaka NHamasaki T.Microscopic posterior transdural resection of cervical retro-odontoid pseudotumors. 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