PMC7395550_01
Perioperative imaging of the cervical spine fusion performed in 2008. (a) Preoperative T1-weighted magnetic resonance imaging (MRI) of the cervical spine. (b) Preoperative T2-weighted MRI of the cervical spine. No significant foci are noted, but canal stenosis is visible from C3-C6. (c) Postoperative X-ray demonstrated instrumented fusion from C3-C7. "L" denotes that the image taken from the left side of the patient's body.
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F1
In 2008, MR showed cervical stenosis with C3-C7 spondylotic myelopathy, for which a C3-C7 laminectomy/instrumented fusion was performed [Figure 1].
Preoperative imaging of the intramedullary spinal cavernoma resection performed in 2019. (a) Preoperative T1-weighted magnetic resonance imaging (MRI) of the cervical spine. (b) Preoperative T2-weighted MRI of the cervical spine. A small but notable signal is visible ventrally at the level of C6 consistent with a focal nodule. A significant signal consistent with peri-nodular edema is also visible from C3-C7.
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F2
The follow- up MR documented a small intramedullary nodule ventrally located at the C5-C6 level accompanied by perinodular edema extending throughout the cord; the lesion remained stable on successive MR studies over the ensuring several months [Figure 2].
Intraoperative imaging of myelotomy and dural opening. (a) Color photo of operative field postmyelotomy. The screws depicted in the top and bottom of the photo correspond to instrumentation at C5, C6, and C7 (from cephalad to caudal) (b) Color photo as in a, with added ruler for the measurement. (c) Color photo of operative field postdural opening.
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F3
Operative findings: The procedure required the utilization of ultrasound, fluoroscopy, and microsurgical technique to perform a C5-C6 midline myelotomy [Figure 3].
Histological examination of cavernous angioma. (a) Hematoxylin and eosin-stained section demonstrating a collection of thin- walled hyalinized vessels surrounded by a thin rim of central nervous system tissue. (b) Immunohistochemical stain for CD34 highlights the vascular endothelium. (c) Immunohistochemical stain for glial fibrillary acidic protein highlights the surrounding reactive astrocytosis in the rim of central nervous system tissue. Of note, there is no appreciable intervening central nervous system tissue between the vessels. (d) Iron stain highlights hemosiderin deposition (blue) indicative of remote hemorrhage. (Magnification x100; all scale bars equal 200 mum).
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F4