PMC10159276_01
Preoperative magnetic resonance images (a). Axial section T1-weighted, (b). sagittal T1 sequence, (c). sagittal T2-weighted (T2W), and (d). post-contrast sagittal with IV contrast of Gadovist showing heterogeneously enhancing intramedullary lesion D11-L1 level with poorly defined margins in the conus medullaris with expansion and abnormal enhancement of the dorsal and ventral rami at L1 level with perilesional edema. (c) Sagittal T2W showed a typical "String of Bead" appearance due to multiple enhancing nodules within the conus associated with interlacing and matting. Copyright 2022 by MIOT International Hospitals, Chennai.
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F1
D11 to L1 with irregular margins in conus medullaris and perilesional edema [Figure 1]. Differential diagnoses of astrocytoma, ependymoma, and granulomatous conditions were suspected, and he was investigated to rule out the differentials.
Intraoperative images (a) edematous and inflamed root, (b) electrode placed after sectioning, (c) exploration of the nerve roots on the left side, (d) dorsal myelotomy performed, and (e) microscopic vision under fluorescein dye. Copyright 2022 by MIOT International Hospital, Chennai. Copyright 2022 by MIOT Internatinoal Hospital, Chennai.
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F2
IgG/IgM to rule out brucellosis and immunoblot antinuclear antibody (ANA) profile to rule out antinuclear antibody-positive disease were reported negative. Systemic involvement of schistosomiasis was ruled out as well. Since there was no definitive diagnosis, a surgical biopsy was contemplated, and therefore, he underwent a laminoplasty proceed biopsy under intraoperative neuromonitoring, C-arm, and fluorescein guidance. Intraoperatively, the edematous and inflamed nerve roots were noted, along with an intramedullary conus lesion [Figure 2].
Histopathological images. (a) The high-power section of Schistosoma eggs, (b) low-power Schistosoma eggs with multinucleated cells showing inflammatory reaction to the egg, and (c) modified Ziehl-Neelsen staining showing Schistosoma eggs. Copyright 2022 by MIOT International Hospital, Chennai.
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F3
Histopathological examination of the spinal cord lesion showed necrotising granulomatous chronic inflammation with Schistosoma eggs and no evidence of malignancy [Figure 3].
Postoperative magnetic resonance images (a). Axial T2-weighted, (b). sagittal T1-weighted (T1W), and (c). sagittal T1W shows a decrease in conus swelling and decreased enhancement in the residual conus medullaris lesion with edema cranial to the conus medullaris completely resolved. Copyright 2022 by MIOT International Hospital, Chennai.
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F4
The postoperative MRI scan showed decreased conus swelling and decreased enhancement in the residual conus medullaris lesion with edema cranial to the conus medullaris completely resolved [Figure 4].