{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:58:33Z","timestamp":1785286713888,"version":"3.55.0"},"reference-count":15,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"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":[[2026,7,27]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Chyle leaks are a rare but recognized complication of neck surgery, most commonly encountered on the left due to thoracic duct (TD) anatomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The authors present an unusual case of a right-sided chyle leak encountered during brachial plexus exposure for nerve transfer for right hemidiaphragm paralysis. Intraoperatively, a moderate leak of milky fluid was identified near a lymph node bed and controlled with suture ligation. Postoperative recovery was uneventful. Right-sided occurrence suggests variant lymphatic anatomy, possibly involving an accessory TD or a large right lymphatic channel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Although uncommon, right-sided chyle leaks may occur during supraclavicular dissection. Awareness of potential anatomical variations, meticulous intraoperative inspection, and prompt recognition allow immediate management and prevention of postoperative morbidity. This case highlights the need for heightened vigilance for lymphatic injury even during nononcological neck procedures.<\/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\/CASE26349\">https:\/\/thejns.org\/doi\/10.3171\/CASE26349<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26349","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:01:32Z","timestamp":1784678492000},"source":"Crossref","is-referenced-by-count":0,"title":["Right-sided chyle leak encountered during supraclavicular brachial plexus exposure: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9786-3061","authenticated-orcid":true,"given":"Jacob","family":"Bethel","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2422-3750","authenticated-orcid":true,"given":"Asma","family":"Eslami","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5062-5952","authenticated-orcid":true,"given":"Amgad S.","family":"Hanna","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison"},{"name":"Department of Biomedical Engineering, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"bib1","series-title":"Head Neck","first-page":"347","article-title":"Systematic approach to the treatment of chylous leakage after neck dissection","volume":"18","author":"de Gier","year":"1996","unstructured":"de Gier HHBalm AJBruning PFGregor RTHilgers FJ.Systematic approach to the treatment of chylous leakage after neck dissection. Head Neck. 1996;18(4):347-351."},{"issue":"1","key":"bib2","series-title":"J Magn Reson Imaging","first-page":"94","article-title":"Morphological features and clinical feasibility of thoracic duct: detection with nonenhanced magnetic resonance imaging at 3.0 T","volume":"32","author":"Yu","year":"2010","unstructured":"Yu DXMa XXZhang XMWang QLi CF.Morphological features and clinical feasibility of thoracic duct: detection with nonenhanced magnetic resonance imaging at 3.0 T. J Magn Reson Imaging. 2010;32(1):94-100. doi:10.1002\/jmri.22128"},{"issue":"2","key":"bib3","series-title":"J Laryngol Otol","first-page":"128","article-title":"The surgical anatomy and clinical relevance of the neglected right lymphatic duct: review","volume":"127","author":"Smith","year":"2013","unstructured":"Smith MERiffat FJani P.The surgical anatomy and clinical relevance of the neglected right lymphatic duct: review. J Laryngol Otol. 2013;127(2):128-133. doi:10.1017\/S0022215112002939"},{"key":"bib4","series-title":"Arch Otolaryngol Rhinol","first-page":"83","article-title":"Management of intra-operative chyle leak during neck dissection: recognition and control","volume":"3","author":"Petruzzelli","year":"2017","unstructured":"Petruzzelli GJ.Management of intra-operative chyle leak during neck dissection: recognition and control. Arch Otolaryngol Rhinol. 2017;3:83-86. doi:10.17352\/2455-1759.000053"},{"issue":"suppl 4","key":"bib5","series-title":"Acta Clin Croat","first-page":"88","article-title":"Management of chyle leak following head and neck surgery: review of current treatment strategies and algorithmic approach","volume":"61","author":"Leovi\u0107","year":"2022","unstructured":"Leovi\u0107 DPastor\u010di\u0107 Grgi\u0107 MGugi\u0107 Radojkovi\u0107 IBlivajs IMatoc LGr\u0161i\u0107 K.Management of chyle leak following head and neck surgery: review of current treatment strategies and algorithmic approach. Acta Clin Croat. 2022;61(suppl 4):88-95. doi:10.20471\/acc.2022.61.s4.11"},{"key":"bib6","series-title":"Int J Otolaryngol","article-title":"Management of chyle leak after head and neck surgery: review of current treatment strategies","volume":"2017","author":"Delaney","year":"2017","unstructured":"Delaney SWShi HShokrani ASinha UK.Management of chyle leak after head and neck surgery: review of current treatment strategies. Int J Otolaryngol. 2017;2017:8362874. doi:10.1155\/2017\/8362874"},{"issue":"2","key":"bib7","series-title":"Curr Opin Otolaryngol Head Neck Surg","first-page":"150","article-title":"Evolution of chylous fistula management after neck dissection","volume":"21","author":"Campisi","year":"2013","unstructured":"Campisi CCBoccardo FPiazza CCampisi C.Evolution of chylous fistula management after neck dissection. Curr Opin Otolaryngol Head Neck Surg. 2013;21(2):150-156. doi:10.1097\/MOO.0b013e32835e9d97"},{"issue":"2","key":"bib8","series-title":"Surg Today","first-page":"330","article-title":"An unusual complication of tumor surgery: chylous leakage","volume":"52","author":"Ardicli","year":"2022","unstructured":"Ardicli BUser IRCiftci AOKarnak ITanyel FCEkinci S.An unusual complication of tumor surgery: chylous leakage. Surg Today. 2022;52(2):330-336. doi:10.1007\/s00595-021-02334-1"},{"issue":"4","key":"bib9","series-title":"Otolaryngol Head Neck Surg","first-page":"575","article-title":"Chyle fistula management","volume":"89","author":"Lucente","year":"1981","unstructured":"Lucente FEDiktaban TLawson WBiller HF.Chyle fistula management. Otolaryngol Head Neck Surg. 1981;89(4):575-578. doi:10.1177\/019459988108900413"},{"issue":"7","key":"bib10","series-title":"Eur J Clin Nutr","first-page":"776","article-title":"Nutritional management in patients with chyle leakage: a systematic review","volume":"69","author":"Steven","year":"2015","unstructured":"Steven BRCarey S.Nutritional management in patients with chyle leakage: a systematic review. Eur J Clin Nutr. 2015;69(7):776-780. doi:10.1038\/ejcn.2015.48"},{"issue":"3","key":"bib11","series-title":"Otolaryngol Head Neck Surg","first-page":"434","article-title":"Management of chyle fistulization in association with neck dissection","volume":"122","author":"Gregor","year":"2000","unstructured":"Gregor RT.Management of chyle fistulization in association with neck dissection. Otolaryngol Head Neck Surg. 2000;122(3):434-439. doi:10.1016\/S0194-5998(00)70061-1"},{"issue":"15","key":"bib12","series-title":"J Clin Med","first-page":"4285","article-title":"The anatomy of the thoracic duct and cisterna chyli: a meta-analysis with surgical implications","volume":"13","author":"Plutecki","year":"2024","unstructured":"Plutecki DBonczar MWilk JThe anatomy of the thoracic duct and cisterna chyli: a meta-analysis with surgical implications. J Clin Med. 2024;13(15):4285. doi:10.3390\/jcm13154285"},{"issue":"suppl 2","key":"bib13","series-title":"Eur Spine J","first-page":"61","article-title":"Chylous fistula: management of a rare complication following right anterior cervical spine approach","volume":"28","author":"Novegno","year":"2019","unstructured":"Novegno FGranaroli PCiccoritti LLunardi PFraioli MF.Chylous fistula: management of a rare complication following right anterior cervical spine approach. Eur Spine J. 2019;28(suppl 2):61-67. doi:10.1007\/s00586-019-05929-y"},{"issue":"8","key":"bib14","series-title":"Act Sci Otalaryngol","first-page":"17","article-title":"Unexpected right side chyle leak in neck dissection","volume":"5","author":"Hammad","year":"2023","unstructured":"Hammad JHIYunus MRMBaki MMMuhammad R.Unexpected right side chyle leak in neck dissection. Act Sci Otalaryngol. 2023;5(8):17-23. doi:10.31080\/asol.2023.05.0588"},{"issue":"5","key":"bib15","series-title":"J Vasc Interv Radiol","first-page":"727","article-title":"Diagnosis and treatment of postoperative chyle leakage via percutaneous transabdominal catheterization of the cisterna chyli: a preliminary study","volume":"9","author":"Cope","year":"1998","unstructured":"Cope C.Diagnosis and treatment of postoperative chyle leakage via percutaneous transabdominal catheterization of the cisterna chyli: a preliminary study. J Vasc Interv Radiol. 1998;9(5):727-734. doi:10.1016\/S1051-0443(98)70382-3"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/4\/article-CASE26349.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/4\/article-CASE26349.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/4\/article-CASE26349.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:01:19Z","timestamp":1785283279000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/4\/article-CASE26349.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":15,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/case26349","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,27]]}}}