PMC7568117_01
(a) T2-W MRI sagittal images disclose a well-defined uniformly hyperintense (identical to CSF) cystic multiseptate lesion extending from the lower end of the T10 vertebral body to the lower end of L2 vertebral body. The bulk of the lesion is seen to create a mass effect and compression over the cauda equina. (b) T1-W MRI sagittal images after contrast injection reveal a well-defined uniform hypointense multiseptate lesion with no evidence of enhancement within the substance or peripheral wall of the lesion. (c and d) T2-W MRI axial images, at the level of T12 and L2, disclose well-defined uniform hyperintense lesion with compression and displacement of conus as well as caudal roots at respective levels. The lesion is seen to be extended into intervertebral foramen at the level of T12.
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F1
T11 to L2 [Figures 1-3], revealing a distended cyst.
(a) Intraoperative picture (under microscope) after T11-L2 laminectomy. Upper pole of large cystic lesion noted hanging over the underlying intact dura, while the inferior end is extending under L1 lamina which was preserved in tailored exposure. (b) Distended cyst wall is seen extending into the left neural foramina between T12 and L1 vertebral level. (c) Distinguished plane between cyst wall and native dura is clearly seen under the cranial pole of the cyst. (d) Distended cyst wall is seen extending into right neural foramina between T12 and L1 vertebral level.
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F2
T11 to L2 [Figures 1-3], revealing a distended cyst.
(a) Intraoperative picture after fenestration and decompression of the cyst, the collapsed wall is seen extending into neural foramina between T12 and L1 vertebral level, where the dural defect was identified and repaired using 4-0 Prolene with muscle patch and fibrin glue. (b) After complete excision of cyst, dura is noted to be adequately decompressed (no evidence of CSF leak on Valsalva maneuver subsequently).
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F3
T11 to L2 [Figures 1-3], revealing a distended cyst.