{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:54:30Z","timestamp":1781657670113,"version":"3.54.5"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"24","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"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":[[2026,6,15]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>CSF-related complications such as CSF leakage and meningitis are well recognized after intramedullary spinal cord tumor surgery. In contrast, postoperative localized ventral intradural CSF collection causing acute spinal cord compression has not been well described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 62-year-old man with an intramedullary spinal cord tumor extending from C6 to T2 and associated extensive syringomyelia underwent tumor resection with posterior decompression and fusion. Gross-total resection was achieved under intraoperative neurophysiological monitoring without immediate neurological deterioration. Approximately 5 hours postoperatively, the patient developed acute paraplegia. Emergency MRI demonstrated a ventral intradural fluid collection with dorsal displacement of the spinal cord. Emergency reoperation demonstrated no evidence of hematoma, and intraoperative ultrasound confirmed a localized ventral intradural CSF accumulation. A markedly thinned segment of the spinal cord with a pinhole-like communication to the ventral intradural space was identified, suggesting a check-valve\u2013like mechanism resulting in a compressive CSF collection. Expansive duraplasty was performed, after which neurological function improved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Localized ventral intradural CSF collection can cause acute neurological deterioration after intramedullary spinal cord tumor surgery, particularly in cases with tumor-associated syringomyelia. Although extremely rare, this condition may be reversible with early recognition and prompt surgical decompression, including expansive duraplasty.<\/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\/CASE26123\">https:\/\/thejns.org\/doi\/10.3171\/CASE26123<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26123","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:35Z","timestamp":1781049635000},"source":"Crossref","is-referenced-by-count":0,"title":["Anterior intradural CSF collection causing postoperative neurological deterioration after intramedullary tumor resection and associated syringomyelia: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Ryo","family":"Nogami","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, St. Michael\u2019s Hospital, University of Toronto, Ontario, Canada;"},{"name":"Department of Neurosurgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wassim","family":"Mazarieb","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, St. Michael\u2019s Hospital, University of Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoru","family":"Tochigi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Cusimano","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, St. Michael\u2019s Hospital, University of Toronto, Ontario, Canada;"},{"name":"Injury Prevention, Department of Surgical Education, St. Michael\u2019s Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"bib1","series-title":"Neurol Neurochir Pol","first-page":"439","article-title":"Surgical treatment of intramedullary ependymomas","volume":"51","author":"Prokopienko","year":"2017","unstructured":"Prokopienko MKunert PPodg\u00f3rska AMarchel A.Surgical treatment of intramedullary ependymomas. Neurol Neurochir Pol. 2017;51(6):439-445. doi:10.1016\/j.pjnns.2017.06.008"},{"issue":"2","key":"bib2","series-title":"J Neurosurg Spine","first-page":"252","article-title":"Perioperative outcomes and survival after surgery for intramedullary spinal cord tumors: a single-institution series of 302 patients","volume":"37","author":"Hersh","year":"2022","unstructured":"Hersh AMPatel JPennington ZPerioperative outcomes and survival after surgery for intramedullary spinal cord tumors: a single-institution series of 302 patients. J Neurosurg Spine. 2022;37(2):252-262. doi:10.3171\/2022.1.Spine211235"},{"issue":"3-4","key":"bib3","series-title":"World Neurosurg","first-page":"344","article-title":"Complications necessitating a return to the operating room following intradural spine surgery","volume":"78","author":"Hoover","year":"2012","unstructured":"Hoover JMClarke MJWetjen NMMandrekar JPuffer RCKrauss WE.Complications necessitating a return to the operating room following intradural spine surgery. World Neurosurg. 2012;78(3-4):344-347. doi:10.1016\/j.wneu.2011.12.085"},{"key":"bib4","series-title":"World Neurosurg","first-page":"e497","article-title":"Cerebrospinal fluid leak and symptomatic pseudomeningocele after intradural spine surgery","volume":"120","author":"Sellin","year":"2018","unstructured":"Sellin JNKolcun JPGLevi AD.Cerebrospinal fluid leak and symptomatic pseudomeningocele after intradural spine surgery. World Neurosurg. 2018;120:e497-e502. doi:10.1016\/j.wneu.2018.08.112"},{"key":"bib5","series-title":"Open Neurol J","first-page":"1","article-title":"Spontaneous CSF collection in the cervical spine may cause neurological deficit and intra-cranial hypotension","volume":"7","author":"Zakaria","year":"2013","unstructured":"Zakaria RWilby MFletcher NA.Spontaneous CSF collection in the cervical spine may cause neurological deficit and intra-cranial hypotension. Open Neurol J. 2013;7:1-3. doi:10.2174\/1874205x01307010001"},{"key":"bib6","series-title":"F1000Res","first-page":"996","article-title":"Hypothesis on the pathophysiology of syringomyelia based on analysis of phase-contrast magnetic resonance imaging of Chiari-I malformation patients","volume":"10","author":"Chang","year":"2021","unstructured":"Chang HS.Hypothesis on the pathophysiology of syringomyelia based on analysis of phase-contrast magnetic resonance imaging of Chiari-I malformation patients. F1000Res. 2021;10:996. doi:10.12688\/f1000research.72823.2"},{"issue":"7","key":"bib7","series-title":"AJNR Am J Neuroradiol","first-page":"1365","article-title":"Acute spontaneous spinal epidural hematomas","volume":"20","author":"Fukui","year":"1999","unstructured":"Fukui MBSwarnkar ASWilliams RL.Acute spontaneous spinal epidural hematomas. AJNR Am J Neuroradiol. 1999;20(7):1365-1372."},{"issue":"1","key":"bib8","series-title":"Acta Radiol","first-page":"8","article-title":"Nontraumatic spinal epidural hematomas. MR features","volume":"38","author":"L\u00f6vblad","year":"1997","unstructured":"L\u00f6vblad KOBaumgartner RWZambaz BDRemonda LOzdoba CSchroth G.Nontraumatic spinal epidural hematomas. MR features. Acta Radiol. 1997;38(1):8-13. doi:10.1080\/02841859709171234"},{"issue":"2","key":"bib9","series-title":"J Neurosurg","first-page":"287","article-title":"Dorsal arachnoid web with spinal cord compression: variant of an arachnoid cyst? Report of two cases","volume":"93","author":"Paramore","year":"2000","unstructured":"Paramore CG.Dorsal arachnoid web with spinal cord compression: variant of an arachnoid cyst? Report of two cases. J Neurosurg. 2000;93(2)(suppl):287-290. doi:10.3171\/spi.2000.93.2.0287"},{"issue":"5","key":"bib10","series-title":"J Neurosurg Spine","first-page":"554","article-title":"Visualization of regional cerebrospinal fluid flow with a dye injection technique in focal arachnoid pathologies","volume":"22","author":"Yamaguchi","year":"2015","unstructured":"Yamaguchi SHida KTakeda MVisualization of regional cerebrospinal fluid flow with a dye injection technique in focal arachnoid pathologies. J Neurosurg Spine. 2015;22(5):554-557. doi:10.3171\/2014.10.Spine1446"},{"issue":"1","key":"bib11","series-title":"Spine J","first-page":"126","article-title":"Spinal arachnoid web\u2014a distinct entity of focal arachnopathy with favorable long-term outcome after surgical resection: analysis of a multicenter patient population","volume":"22","author":"Voglis","year":"2022","unstructured":"Voglis SRomagna AGermans MRSpinal arachnoid web\u2014a distinct entity of focal arachnopathy with favorable long-term outcome after surgical resection: analysis of a multicenter patient population. Spine J. 2022;22(1):126-135. doi:10.1016\/j.spinee.2021.06.018"},{"issue":"3","key":"bib12","series-title":"J Ultrasound","first-page":"195","article-title":"Intraoperative ultrasound in spinal tumor surgery","volume":"17","author":"Prada","year":"2014","unstructured":"Prada FVetrano IGFilippini AIntraoperative ultrasound in spinal tumor surgery. J Ultrasound. 2014;17(3):195-202. doi:10.1007\/s40477-014-0102-9"},{"issue":"6","key":"bib1","series-title":"Neurol Neurochir Pol","first-page":"439","article-title":"Surgical treatment of intramedullary ependymomas","volume":"51","author":"Prokopienko","year":"2017","unstructured":"Prokopienko MKunert PPodg\u00f3rska AMarchel A.Surgical treatment of intramedullary ependymomas. Neurol Neurochir Pol. 2017;51(6):439-445. doi:10.1016\/j.pjnns.2017.06.008"},{"issue":"2","key":"bib2","series-title":"J Neurosurg Spine","first-page":"252","article-title":"Perioperative outcomes and survival after surgery for intramedullary spinal cord tumors: a single-institution series of 302 patients","volume":"37","author":"Hersh","year":"2022","unstructured":"Hersh AMPatel JPennington ZPerioperative outcomes and survival after surgery for intramedullary spinal cord tumors: a single-institution series of 302 patients. 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World Neurosurg. 2018;120:e497-e502. doi:10.1016\/j.wneu.2018.08.112"},{"key":"bib5","series-title":"Open Neurol J","first-page":"1","article-title":"Spontaneous CSF collection in the cervical spine may cause neurological deficit and intra-cranial hypotension","volume":"7","author":"Zakaria","year":"2013","unstructured":"Zakaria RWilby MFletcher NA.Spontaneous CSF collection in the cervical spine may cause neurological deficit and intra-cranial hypotension. Open Neurol J. 2013;7:1-3. doi:10.2174\/1874205x01307010001"},{"key":"bib6","series-title":"F1000Res","first-page":"996","article-title":"Hypothesis on the pathophysiology of syringomyelia based on analysis of phase-contrast magnetic resonance imaging of Chiari-I malformation patients","volume":"10","author":"Chang","year":"2021","unstructured":"Chang HS.Hypothesis on the pathophysiology of syringomyelia based on analysis of phase-contrast magnetic resonance imaging of Chiari-I malformation patients. F1000Res. 2021;10:996. doi:10.12688\/f1000research.72823.2"},{"issue":"7","key":"bib7","series-title":"AJNR Am J Neuroradiol","first-page":"1365","article-title":"Acute spontaneous spinal epidural hematomas","volume":"20","author":"Fukui","year":"1999","unstructured":"Fukui MBSwarnkar ASWilliams RL.Acute spontaneous spinal epidural hematomas. AJNR Am J Neuroradiol. 1999;20(7):1365-1372."},{"issue":"1","key":"bib8","series-title":"Acta Radiol","first-page":"8","article-title":"Nontraumatic spinal epidural hematomas. MR features","volume":"38","author":"L\u00f6vblad","year":"1997","unstructured":"L\u00f6vblad KOBaumgartner RWZambaz BDRemonda LOzdoba CSchroth G.Nontraumatic spinal epidural hematomas. MR features. Acta Radiol. 1997;38(1):8-13. doi:10.1080\/02841859709171234"},{"issue":"2","key":"bib9","series-title":"J Neurosurg","first-page":"287","article-title":"Dorsal arachnoid web with spinal cord compression: variant of an arachnoid cyst? Report of two cases","volume":"93","author":"Paramore","year":"2000","unstructured":"Paramore CG.Dorsal arachnoid web with spinal cord compression: variant of an arachnoid cyst? Report of two cases. J Neurosurg. 2000;93(2)(suppl):287-290. doi:10.3171\/spi.2000.93.2.0287"},{"issue":"5","key":"bib10","series-title":"J Neurosurg Spine","first-page":"554","article-title":"Visualization of regional cerebrospinal fluid flow with a dye injection technique in focal arachnoid pathologies","volume":"22","author":"Yamaguchi","year":"2015","unstructured":"Yamaguchi SHida KTakeda MVisualization of regional cerebrospinal fluid flow with a dye injection technique in focal arachnoid pathologies. J Neurosurg Spine. 2015;22(5):554-557. doi:10.3171\/2014.10.Spine1446"},{"issue":"1","key":"bib11","series-title":"Spine J","first-page":"126","article-title":"Spinal arachnoid web\u2014a distinct entity of focal arachnopathy with favorable long-term outcome after surgical resection: analysis of a multicenter patient population","volume":"22","author":"Voglis","year":"2022","unstructured":"Voglis SRomagna AGermans MRSpinal arachnoid web\u2014a distinct entity of focal arachnopathy with favorable long-term outcome after surgical resection: analysis of a multicenter patient population. Spine J. 2022;22(1):126-135. doi:10.1016\/j.spinee.2021.06.018"},{"issue":"3","key":"bib12","series-title":"J Ultrasound","first-page":"195","article-title":"Intraoperative ultrasound in spinal tumor surgery","volume":"17","author":"Prada","year":"2014","unstructured":"Prada FVetrano IGFilippini AIntraoperative ultrasound in spinal tumor surgery. J Ultrasound. 2014;17(3):195-202. doi:10.1007\/s40477-014-0102-9"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/24\/article-CASE26123.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/24\/article-CASE26123.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/24\/article-CASE26123.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:22:33Z","timestamp":1781655753000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/24\/article-CASE26123.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,15]]},"references-count":24,"journal-issue":{"issue":"24"},"URL":"https:\/\/doi.org\/10.3171\/case26123","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,15]]}}}