PMC7193206_01
Pre-operative T2-weighted MRI sagittal (a) and axial (b) images show a "hawk-beak like" appearance at L1-L2 level, suspecting an intradural herniated disc (yellow asterisk).
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F1
The lesion itself at L1-L2 did not enhance with contrast, but there was enhancement of the surroundings tissues [Figure 1].
Intraoperative description of the IDH removal. After the L1-L2 laminectomy, a dural incision is made. The roots of the cauda equina (black arrow) appear dislocated by a voluminous migrated intradural disc fragment. (black asterisk) (a) With the use of disc pounches a removal of the voluminous IDH is performed. (b) Microsurgical discectomy is completed with the use of a Cushing's buttoned nerve hook (black asterisk) through the ventral dural defect (c), achieving a macroscopic complete disc removal and decompression of the nerve roots (black arrow). (d).
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F2
This was carefully teased away under the operating microscope from the surrounding nerve roots of the cauda equina and ventral dura [Figure 2].
Post-operative T2-weighted MRI sagittal (a) and axial (b) images show an optimal decompression of the conus medullaris and of the roots of the cauda equina with absence of further disc fragments.
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F3
One week postoperatively, the lumbar MR confirmed adequate decompression of the spinal canal without any residual disc [Figure 3].