PMC3358956_01
T1 weighted, T2 weighted and post contrast sagittal MRI showing cervico-medullary intramedullary tumour with lower ventral exophytic component
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F1
The sagittal magnetic resonance imaging (MRI) revealed a cervicomedullary lesion with an exophytic portion in the lower half, lying ventral to the cord [Figure 1].
Axial T2 weighted showing the ventral portion and post contrast images showing eccentricity to the left
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F2
The axial images showed its eccentricity to the left [Figure 2].
The ventral exophytic component incised with an arachnoid knife and Dorsal root entry zone incision was given to access the upper intramedullary tumour with piecemeal excision being carried out with tumour forceps
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F3
The tumor removal was started from below where the exophytic portion was tackled first between the roots [Figure 3], and as we moved up the cord the left DREZ [Figure 4] was incised to approach the upper intramedullary component.
The histopathology confirming the diagnosis of pilocytic astrocytoma (Rosenthal fibres along with typical biphasic appearance)
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F4
The tumor removal was started from below where the exophytic portion was tackled first between the roots [Figure 3], and as we moved up the cord the left DREZ [Figure 4] was incised to approach the upper intramedullary component.
Immediate post-operative contrast MRI showing adequate excision and no residual contrast enhancing regions
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F5
Piecemeal excision was done with the help of ultrasonic surgical aspirator and tumor forceps [Figure 5] and gross total excision was possible.
Contrast enhancing intramedullary tumour extending from C2 to D2 levels
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F6
The postoperative MRI revealed complete excision without any contrast-enhancing areas [Figure 6].
PMC3358956_02
Axial sections showing eccentricity to right side of spinal cord
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F7
The MRI showed an intramedullary tumor enhancing sharply after contrast extending from C2 to D1 region [Figure 7].
Immediate post-operative T2 weighted images showing gross total excision of tumour with residual cavity
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F8
The axial sections revealed the lesion to be eccentrically placed [Figure 8].
Axial sections showing the gross total excision of the lesion and residual cavity with preservation of posterior cord substance
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F9
Hence, it was approached from the right DREZ and gross total excision was achieved [Figure 9].