PMC8769426_01
Preoperative spinal MRI demonstrated an intradural extramedullary lesion strongly compressing the spinal cord at the T6/7 level, which was accompanied with dural tail sign and perilesional meningeal thickening at the T6-T8 levels. The lesion was isointense on sagittal T1-weighted imaging (A), iso- to slightly hyperintense on sagittal T2-weighted imaging (B), and homogeneously enhanced with small hypointense areas inside the lesion on enhanced sagittal T1-weighted imaging (C). Axial enhanced T1-weighted imaging at the T6/7 level (E) revealed a mass lesion compressing the spinal cord from the left-dorsal side. Axial enhanced T1-weighted imaging at the levels of T1 (D) and T8 (F) revealed a small intradural extramedullary lesion with a homogenous contrast enhancement.
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T6/7 level, which was accompanied with dural tail sign and perilesional meningeal thickening at the T6-T8 levels. The lesion was isointense on T1-weighted imaging and iso- to slightly hyperintense on T2-weighted imaging, with homogeneous enhancement and small hypointense areas inside the lesion after contrast injection (Fig. 1A-C and 1E). T1 and T8 levels (Fig. 1D and 1F). The main lesions at the T6/7-T8 levels had no continuity with the remote lesion at the T1 level because the dura mater between the T1 and T6 levels was not thickened and had no contrast enhancement.
Microscopic intraoperative findings (A-C): the intradural extramedullary lesion at the T6/7 level, which was whitish, elastic, and hard, had continuity with the dura mater (A). The lesion strongly adhered to the spinal cord and was dissected from the dura mater (B). The lesion was detached from the spinal cord and totally removed, which achieved sufficient decompression of the spinal cord (C). Histopathological examination revealed an epithelioid granuloma with infiltration of inflammatory cells, such as lymphocytes and plasmatocytes, and with focal necrosis (D: hematoxylin and eosin staining; magnification x200).
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Total resection of the lesion achieved sufficient decompression of the spinal cord (Fig. 2A-C). These histopathological findings were consistent with CNS syphilitic gumma (Fig. 2D).
Follow-up sagittal T1-weighted (A) and enhanced T1-weighted (B) MR images after postoperative antibiotic treatment revealed complete resection of the lesion at the T6/7-T8 levels and sufficient decompression of the spinal cord. Axial-enhanced T1-weighted imaging at the T1 level revealed the resolution of another small lesion (C: pre- and D: post-antibiotic treatment).
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MRI after the antibiotic treatment revealed complete resection of the lesion at the T6/7-T8 levels and sufficient decompression of the spinal cord (Fig. 3A and 3B). Moreover, another residual small lesion at the T1 level was resolved (Fig. 3C and 3D), which also confirmed the diagnosis of spinal syphilitic gumma.