{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:26:31Z","timestamp":1787099191647,"version":"build-2736575974"},"reference-count":10,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"7","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"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":[[2026,8,17]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Spontaneous intracranial hypotension results from CSF loss due to a dural defect or meningeal diverticulum. Precise localization of the leak is challenging, especially when multiple levels present abnormalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 58-year-old woman presented with progressive orthostatic headache, with no history of trauma. MRI of the brain showed signs of CSF hypotension, while MRI of the spine revealed Tarlov cysts in the left T12 and L1 roots. CT myelography suggested a CSF-venous fistula leak at the right T7 level. Three thoracic epidural blood patches were performed with no improvement. As the patient\u2019s condition progressed and she developed right abducens nerve paresis, surgical exploration was indicated. The level of the presumed CSF-venous leak (T7) was explored, and no anomalous drainage was found. Then the Tarlov cysts at T12 and L1 were addressed. A dural defect with spontaneous CSF leakage was found on the dorsal surface of the nerve root of the L1 cyst, which ceased with suturing. Postoperatively, there was significant improvement of the patient\u2019s headache and right abducens paresis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Even in a presumed diagnosis of CSF-venous fistula, exploration of Tarlov cysts may reveal a dural defect and CSF leakage. Therefore, surgical decision-making should include a critical analysis of Tarlov cysts for definitive repair.<\/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\/CASE25871\">https:\/\/thejns.org\/doi\/10.3171\/CASE25871<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25871","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:01:08Z","timestamp":1787097668000},"source":"Crossref","is-referenced-by-count":0,"title":["Dural defect in Tarlov cyst instead of cerebrospinal fluid\u2013venous fistula as the cause of spontaneous intracranial hypotension: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9018-2746","authenticated-orcid":true,"given":"Ricardo Vieira","family":"Botelho","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Instituto de Assist\u00eancia M\u00e9dica ao Servidor P\u00fablico Estadual (IAMSPE), S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o Carlos Teixeira","family":"Leal Filho","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Instituto de Assist\u00eancia M\u00e9dica ao Servidor P\u00fablico Estadual (IAMSPE), S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel Bertelli","family":"Ramos","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Instituto de Assist\u00eancia M\u00e9dica ao Servidor P\u00fablico Estadual (IAMSPE), S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo de Freitas","family":"Bertolini","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Instituto de Assist\u00eancia M\u00e9dica ao Servidor P\u00fablico Estadual (IAMSPE), S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Marcus","family":"Rotta","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Instituto de Assist\u00eancia M\u00e9dica ao Servidor P\u00fablico Estadual (IAMSPE), S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"J Clin Neurosci","first-page":"39","article-title":"CSF hypotension: a review of its manifestations, investigation and management","volume":"34","author":"Pattichis","year":"2016","unstructured":"Pattichis AASlee M.CSF hypotension: a review of its manifestations, investigation and management. J Clin Neurosci. 2016;34:39-43. doi:10.1016\/j.jocn.2016.07.002"},{"issue":"11","key":"bib2","series-title":"Mayo Clin Proc","first-page":"1113","article-title":"Spontaneous cerebrospinal fluid leaks: from intracranial hypotension to cerebrospinal fluid hypovolemia\u2014evolution of a concept","volume":"74","author":"Mokri","year":"1999","unstructured":"Mokri B.Spontaneous cerebrospinal fluid leaks: from intracranial hypotension to cerebrospinal fluid hypovolemia\u2014evolution of a concept. Mayo Clin Proc. 1999;74(11):1113-1123. doi:10.4065\/74.11.1113"},{"issue":"8","key":"bib3","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":"8","key":"bib4","series-title":"Headache","first-page":"1394","article-title":"Quantitative analysis of thecal sac volume and morphology as a diagnostic tool in intracranial hypotension","volume":"65","author":"Knievel","year":"2025","unstructured":"Knievel KAlhilali LMushtaq RQuantitative analysis of thecal sac volume and morphology as a diagnostic tool in intracranial hypotension. Headache. 2025;65(8):1394-1402. doi:10.1111\/head.15014"},{"issue":"24","key":"bib5","series-title":"Neurology","first-page":"2310","article-title":"Spinal CSF venous fistula: a treatable etiology for CSF leaks in craniospinal hypovolemia","volume":"86","author":"Kumar","year":"2016","unstructured":"Kumar NDiehn FECarr CMSpinal CSF venous fistula: a treatable etiology for CSF leaks in craniospinal hypovolemia. Neurology. 2016;86(24):2310-2312. doi:10.1212\/wnl.0000000000002776"},{"issue":"5","key":"bib6","series-title":"Neurology","first-page":"472","article-title":"CSF\u2013venous fistula in spontaneous intracranial hypotension","volume":"83","author":"Schievink","year":"2014","unstructured":"Schievink WIMoser FGMaya MM.CSF\u2013venous fistula in spontaneous intracranial hypotension. Neurology. 2014;83(5):472-473. doi:10.1212\/WNL.0000000000000639"},{"issue":"4","key":"bib7","series-title":"AJNR Am J Neuroradiol","first-page":"1128","article-title":"Spine MRI diverticular patterns predict CSF-venous fistula location: a 100-patient study","volume":"47","author":"Mamlouk","year":"2026","unstructured":"Mamlouk MDLatoff JFRGutierrez ASedrak MF.Spine MRI diverticular patterns predict CSF-venous fistula location: a 100-patient study. AJNR Am J Neuroradiol. 2026;47(4):1128-1134. doi:10.3174\/ajnr.A9042"},{"issue":"2","key":"bib8","series-title":"Radiographics","first-page":"470","article-title":"CT myelography: clinical indications and imaging findings","volume":"40","author":"Patel","year":"2020","unstructured":"Patel DMWeinberg BDHoch MJ.CT myelography: clinical indications and imaging findings. Radiographics. 2020;40(2):470-484. doi:10.1148\/rg.2020190135"},{"issue":"10","key":"bib9","series-title":"AJNR Am J Neuroradiol","first-page":"1403","article-title":"Myelographic techniques for the localization of CSF-venous fistulas: updates in 2024","volume":"45","author":"Madhavan","year":"2024","unstructured":"Madhavan AABrinjikji WCutsforth-Gregory JKMyelographic techniques for the localization of CSF-venous fistulas: updates in 2024. AJNR Am J Neuroradiol. 2024;45(10):1403-1412. doi:10.3174\/ajnr.A8299"},{"issue":"6","key":"bib10","series-title":"Surg Radiol Anat","first-page":"855","article-title":"Global incidence of spinal perineural Tarlov\u2019s cysts and their morphological characteristics: a meta-analysis of 13,266 subjects","volume":"43","author":"Klepinowski","year":"2021","unstructured":"Klepinowski TOrbik WSagan L.Global incidence of spinal perineural Tarlov\u2019s cysts and their morphological characteristics: a meta-analysis of 13,266 subjects. Surg Radiol Anat. 2021;43(6):855-863. doi:10.1007\/s00276-020-02644-y"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/7\/article-CASE25871.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/7\/article-CASE25871.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/7\/article-CASE25871.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:01:09Z","timestamp":1787097669000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/7\/article-CASE25871.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,17]]},"references-count":10,"journal-issue":{"issue":"7"},"URL":"https:\/\/doi.org\/10.3171\/case25871","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,17]]}}}