PMC10316147_01
Preoperative magnetic resonance images obtained in the patient. T2-weighted sagittal (a) revealed a "scalpel sign" at the T7 segment (red arrow). The T7 axial image (b) showed spinal cord deviation (red arrow).
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F1
On the T2-weighted sagittal image, there was a sharp dorsal indentation of the spinal cord consistent with the positive "scalpel sign" [Figures 1a and b].
(a) Intraoperative visualization of the arachnoid web following a T7 durotomy to expose the web (arrow). (b) Indentation of the cord (arrowheads) following lysis of the arachnoid tissue band.
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F2
The dura was exposed in the midline, and the arachnoid web (AW) was immediately visualized [Figure 2a]. T7 level was carefully microdissected under a surgical microscope, and adherent fibrous tissue was carefully and meticulously removed freeing the cord [Figure 2b]. The T6-T8 fusion utilized fixed plates and titanium screws. The histological findings were consistent with a DAW and included low columnar epithelial cells and fibrous tissue but no malignant cells.
(a and b) Postoperative sagittal and axial magnetic resonance imaging showed vanished "scalpel sign" and no spinal cord deviation.
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F3
MRI 6 months after surgery showed that the scalpel sign had disappeared, and the spinal cord was no longer deviated [Figure 3].