{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:07:39Z","timestamp":1776096459433,"version":"3.50.1"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"10","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"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":[[2026,3,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Retro-odontoid pannus can cause craniocervical instability and cervicomedullary compression. Occipitocervical fusion (OCF) is an established treatment, but hardware-related complications remain significant. Intracranial rod migration through the foramen magnum is exceedingly rare and poses substantial neurological risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 76-year-old man with retro-odontoid pannus and progressive myelopathy underwent OCF. Months later, he developed wound complications and mechanical failure. Imaging revealed superior rod migration with erosion through the foramen magnum and intracranial extension. A staged surgical strategy was utilized: initial hardware removal and soft tissue reconstruction, followed by targeted left suboccipital craniectomy, durotomy, and ultrasound-guided extraction of the migrated rod. Revision C1 laminectomy and allograft C1\u20132 arthrodesis restored construct stability. The patient recovered without new neurological deficits and experienced improvement in gait imbalance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Intracranial rod erosion after OCF is rare but should be suspected in the presence of wound breakdown, new posterior fossa symptoms, or construct instability. Prevention requires meticulous rod contouring to avoid occipital contact, secure cranial fixation, and early postoperative surveillance. Management benefits from multidisciplinary collaboration and intraoperative ultrasound for safe extraction in anatomically constrained regions.<\/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\/CASE25837\">https:\/\/thejns.org\/doi\/10.3171\/CASE25837<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25837","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:13:02Z","timestamp":1773925982000},"source":"Crossref","is-referenced-by-count":0,"title":["Intracranial erosion of an occipitocervical rod through the foramen magnum following occipitocervical fusion for retro-odontoid pannus: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2386-5471","authenticated-orcid":true,"given":"Arun","family":"Gunasekaran","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fielding","family":"Horne","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maxwell","family":"Sheedy","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7101-0981","authenticated-orcid":true,"given":"Brian Fabian","family":"Saway","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3360-6087","authenticated-orcid":true,"given":"Joel","family":"Sirianni","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven L.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3345-9630","authenticated-orcid":true,"given":"Amanda L.","family":"Faulkner","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Eur Spine J","first-page":"366","article-title":"Pannus resolution after occipitocervical fusion in a non-rheumatoid atlanto-axial instability","volume":"15","author":"Lagares","year":"2006","unstructured":"Lagares AArrese IPascual BG\u00f2mez PARamos ALobato RD.Pannus resolution after occipitocervical fusion in a non-rheumatoid atlanto-axial instability. Eur Spine J. 2006;15(3):366-369. doi:10.1007\/s00586-005-0969-4"},{"issue":"1","key":"bib2","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. doi:10.14245\/ns.2040402.201"},{"issue":"1","key":"bib3","series-title":"Sci Rep","first-page":"20035","article-title":"Changes in retro-odontoid mass after upper cervical spine surgery","volume":"12","author":"Shin","year":"2022","unstructured":"Shin JWSuk KSKim HSChanges in retro-odontoid mass after upper cervical spine surgery. Sci Rep. 2022;12(1):20035. doi:10.1038\/s41598-022-24436-7"},{"key":"bib4","series-title":"N Am Spine Soc J","article-title":"Comparison of fusion versus non-fusion surgery for retro-odontoid pseudotumor with atlanto-axial subluxation","volume":"6","author":"Uehara","year":"2021","unstructured":"Uehara MIkegami SKuraishi SComparison of fusion versus non-fusion surgery for retro-odontoid pseudotumor with atlanto-axial subluxation. N Am Spine Soc J. 2021;6:100064. doi:10.1016\/j.xnsj.2021.100064"},{"issue":"2","key":"bib5","series-title":"Eur Spine J","first-page":"311","article-title":"Complications of occipitocervical fixation: retrospective review of 128 patients with 5-year mean follow-up","volume":"31","author":"Zileli","year":"2022","unstructured":"Zileli MAk\u0131nt\u00fcrk N.Complications of occipitocervical fixation: retrospective review of 128 patients with 5-year mean follow-up. Eur Spine J. 2022;31(2):311-326. doi:10.1007\/s00586-021-07037-2"},{"issue":"4","key":"bib6","series-title":"J Korean Neurosurg Soc","first-page":"223","article-title":"Surgical outcomes and complications after occipito-cervical fusion using the screw-rod system in craniocervical instability","volume":"53","author":"Choi","year":"2013","unstructured":"Choi SHLee SGPark CWKim WKYoo CJSon S.Surgical outcomes and complications after occipito-cervical fusion using the screw-rod system in craniocervical instability. J Korean Neurosurg Soc. 2013;53(4):223-227. doi:10.3340\/jkns.2013.53.4.223"},{"issue":"5","key":"bib7","series-title":"J Neurol Surg B Skull Base","first-page":"331","article-title":"Occipitocervical fusion surgery: review of operative techniques and results","volume":"76","author":"Kukreja","year":"2015","unstructured":"Kukreja SAmbekar SSin AHNanda A.Occipitocervical fusion surgery: review of operative techniques and results. J Neurol Surg B Skull Base. 2015;76(5):331-339. doi:10.1055\/s-0034-1543967"},{"issue":"4","key":"bib8","series-title":"Acta Neurochir (Wien)","first-page":"741","article-title":"A case report of rod migration into cerebellum through foramen magnum after lateral mass fixation of cervical spine","volume":"158","author":"Kiran","year":"2016","unstructured":"Kiran BSharma APrashant GParekh A.A case report of rod migration into cerebellum through foramen magnum after lateral mass fixation of cervical spine. Acta Neurochir (Wien). 2016;158(4):741-744. doi:10.1007\/s00701-015-2693-0"},{"key":"bib9","series-title":"Surg Neurol Int","article-title":"Rod migration through foramen magnum into posterior fossa after cervical spine lateral mass fixation: a case report and literature review","volume":"13","author":"Ezzat","year":"2022","unstructured":"Ezzat AASalah AM.Rod migration through foramen magnum into posterior fossa after cervical spine lateral mass fixation: a case report and literature review. Surg Neurol Int. 2022;13:514. doi:10.25259\/SNI_866_2022"},{"issue":"1","key":"bib10","series-title":"Indian J Neurosurg","first-page":"73","article-title":"Rod migration into the posterior cranial fossa after C1\u2013C2\u2013C3\u2013C4 screw fixation: case report and review of the literature","volume":"13","author":"Basankin","year":"2023","unstructured":"Basankin IVPorkhanov VAGiulzatyan AARod migration into the posterior cranial fossa after C1\u2013C2\u2013C3\u2013C4 screw fixation: case report and review of the literature. Indian J Neurosurg. 2023;13(1):73-75. doi:10.1055\/s-0043-1775735"},{"issue":"6","key":"bib11","series-title":"Acta Orthop Traumatol Turc","first-page":"606","article-title":"Occipital bone thickness: implications on occipital-cervical fusion. A cadaveric study","volume":"50","author":"Zarghooni","year":"2016","unstructured":"Zarghooni KBoese CKSiewe JR\u00f6llinghoff MEysel PScheyerer MJ.Occipital bone thickness: implications on occipital-cervical fusion. A cadaveric study. Acta Orthop Traumatol Turc. 2016;50(6):606-609. doi:10.1016\/j.aott.2016.04.003"},{"issue":"3","key":"bib12","series-title":"Spine (Phila Pa 1976)","article-title":"Migration of rod through skull, into brain following C1\u2013C2 instrumental fusion for os Odontoideum: a case report","volume":"35","author":"Plant","year":"2010","unstructured":"Plant JGARuff SJ.Migration of rod through skull, into brain following C1\u2013C2 instrumental fusion for os Odontoideum: a case report. Spine (Phila Pa 1976). 2010;35(3):E90-E92. doi:10.1097\/BRS.0b013e3181ba03b3"},{"issue":"3","key":"bib13","series-title":"Spine (Phila Pa 1976)","first-page":"356","article-title":"The migration of a Harrington rod after cervical fusion","volume":"18","author":"Yablon","year":"1993","unstructured":"Yablon IGCowan SMortara R.The migration of a Harrington rod after cervical fusion. Spine (Phila Pa 1976). 1993;18(3):356-358. doi:10.1097\/00007632-199303000-00009"},{"issue":"3","key":"bib14","series-title":"J Korean Neurosurg Soc","first-page":"221","article-title":"Rod migration into the posterior fossa after harms operation: case report and review of literatures","volume":"47","author":"Chun","year":"2010","unstructured":"Chun HJBak KHKang THYi HJ.Rod migration into the posterior fossa after harms operation: case report and review of literatures. J Korean Neurosurg Soc. 2010;47(3):221-223. doi:10.3340\/jkns.2010.47.3.221"},{"key":"bib15","series-title":"World Neurosurg","first-page":"178","article-title":"Cranial settling causing intracranial hemorrhage through violation of the skull base by cervical spine instrumentation","volume":"145","author":"Mahtabfar","year":"2021","unstructured":"Mahtabfar AMazza JFranco DCranial settling causing intracranial hemorrhage through violation of the skull base by cervical spine instrumentation. World Neurosurg. 2021;145:178-182. doi:10.1016\/j.wneu.2020.08.193"},{"issue":"3","key":"bib1","series-title":"Eur Spine J","first-page":"366","article-title":"Pannus resolution after occipitocervical fusion in a non-rheumatoid atlanto-axial instability","volume":"15","author":"Lagares","year":"2006","unstructured":"Lagares AArrese IPascual BG\u00f2mez PARamos ALobato RD.Pannus resolution after occipitocervical fusion in a non-rheumatoid atlanto-axial instability. Eur Spine J. 2006;15(3):366-369. doi:10.1007\/s00586-005-0969-4"},{"issue":"1","key":"bib2","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. doi:10.14245\/ns.2040402.201"},{"issue":"1","key":"bib3","series-title":"Sci Rep","first-page":"20035","article-title":"Changes in retro-odontoid mass after upper cervical spine surgery","volume":"12","author":"Shin","year":"2022","unstructured":"Shin JWSuk KSKim HSChanges in retro-odontoid mass after upper cervical spine surgery. Sci Rep. 2022;12(1):20035. doi:10.1038\/s41598-022-24436-7"},{"key":"bib4","series-title":"N Am Spine Soc J","article-title":"Comparison of fusion versus non-fusion surgery for retro-odontoid pseudotumor with atlanto-axial subluxation","volume":"6","author":"Uehara","year":"2021","unstructured":"Uehara MIkegami SKuraishi SComparison of fusion versus non-fusion surgery for retro-odontoid pseudotumor with atlanto-axial subluxation. N Am Spine Soc J. 2021;6:100064. doi:10.1016\/j.xnsj.2021.100064"},{"issue":"2","key":"bib5","series-title":"Eur Spine J","first-page":"311","article-title":"Complications of occipitocervical fixation: retrospective review of 128 patients with 5-year mean follow-up","volume":"31","author":"Zileli","year":"2022","unstructured":"Zileli MAk\u0131nt\u00fcrk N.Complications of occipitocervical fixation: retrospective review of 128 patients with 5-year mean follow-up. Eur Spine J. 2022;31(2):311-326. doi:10.1007\/s00586-021-07037-2"},{"issue":"4","key":"bib6","series-title":"J Korean Neurosurg Soc","first-page":"223","article-title":"Surgical outcomes and complications after occipito-cervical fusion using the screw-rod system in craniocervical instability","volume":"53","author":"Choi","year":"2013","unstructured":"Choi SHLee SGPark CWKim WKYoo CJSon S.Surgical outcomes and complications after occipito-cervical fusion using the screw-rod system in craniocervical instability. J Korean Neurosurg Soc. 2013;53(4):223-227. doi:10.3340\/jkns.2013.53.4.223"},{"issue":"5","key":"bib7","series-title":"J Neurol Surg B Skull Base","first-page":"331","article-title":"Occipitocervical fusion surgery: review of operative techniques and results","volume":"76","author":"Kukreja","year":"2015","unstructured":"Kukreja SAmbekar SSin AHNanda A.Occipitocervical fusion surgery: review of operative techniques and results. J Neurol Surg B Skull Base. 2015;76(5):331-339. doi:10.1055\/s-0034-1543967"},{"issue":"4","key":"bib8","series-title":"Acta Neurochir (Wien)","first-page":"741","article-title":"A case report of rod migration into cerebellum through foramen magnum after lateral mass fixation of cervical spine","volume":"158","author":"Kiran","year":"2016","unstructured":"Kiran BSharma APrashant GParekh A.A case report of rod migration into cerebellum through foramen magnum after lateral mass fixation of cervical spine. Acta Neurochir (Wien). 2016;158(4):741-744. doi:10.1007\/s00701-015-2693-0"},{"key":"bib9","series-title":"Surg Neurol Int","article-title":"Rod migration through foramen magnum into posterior fossa after cervical spine lateral mass fixation: a case report and literature review","volume":"13","author":"Ezzat","year":"2022","unstructured":"Ezzat AASalah AM.Rod migration through foramen magnum into posterior fossa after cervical spine lateral mass fixation: a case report and literature review. Surg Neurol Int. 2022;13:514. doi:10.25259\/SNI_866_2022"},{"issue":"1","key":"bib10","series-title":"Indian J Neurosurg","first-page":"73","article-title":"Rod migration into the posterior cranial fossa after C1\u2013C2\u2013C3\u2013C4 screw fixation: case report and review of the literature","volume":"13","author":"Basankin","year":"2023","unstructured":"Basankin IVPorkhanov VAGiulzatyan AARod migration into the posterior cranial fossa after C1\u2013C2\u2013C3\u2013C4 screw fixation: case report and review of the literature. Indian J Neurosurg. 2023;13(1):73-75. doi:10.1055\/s-0043-1775735"},{"issue":"6","key":"bib11","series-title":"Acta Orthop Traumatol Turc","first-page":"606","article-title":"Occipital bone thickness: implications on occipital-cervical fusion. A cadaveric study","volume":"50","author":"Zarghooni","year":"2016","unstructured":"Zarghooni KBoese CKSiewe JR\u00f6llinghoff MEysel PScheyerer MJ.Occipital bone thickness: implications on occipital-cervical fusion. A cadaveric study. Acta Orthop Traumatol Turc. 2016;50(6):606-609. doi:10.1016\/j.aott.2016.04.003"},{"issue":"3","key":"bib12","series-title":"Spine (Phila Pa 1976)","article-title":"Migration of rod through skull, into brain following C1\u2013C2 instrumental fusion for os Odontoideum: a case report","volume":"35","author":"Plant","year":"2010","unstructured":"Plant JGARuff SJ.Migration of rod through skull, into brain following C1\u2013C2 instrumental fusion for os Odontoideum: a case report. Spine (Phila Pa 1976). 2010;35(3):E90-E92. doi:10.1097\/BRS.0b013e3181ba03b3"},{"issue":"3","key":"bib13","series-title":"Spine (Phila Pa 1976)","first-page":"356","article-title":"The migration of a Harrington rod after cervical fusion","volume":"18","author":"Yablon","year":"1993","unstructured":"Yablon IGCowan SMortara R.The migration of a Harrington rod after cervical fusion. 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