PMC8247677_01
Preoperative magnetic resonance images. (a) T2-weighted image showing a high-intensity small tumor (arrowheads) at the L4 level. (b): Axial T2-weighted image at the L4 level showing absence of the L4 nerve root (arrows).
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F1
The MRI with/without contrast revealed a small intradural extramedullary mass at the L4 level; the lesion was hypointense on T1-weighted images, hyperintense on T2-weighted images, and homogeneously enhanced with contrast (size: 9 x 12 x 12 mm, occupying 34% of the spinal canal in the axial view) [Figures 1 and 2]. T2-weighted MR image [Figure 1b]. The CT myelogram revealed that the tumor had originated from the left L4 ventral root, and contributed to lateral recess compromise [Figure 3].
Preoperative contrast-enhanced magnetic resonance images showing a well-defined intradural extramedullary tumor (arrowheads) with homogeneous enhancement.
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F2
The MRI with/without contrast revealed a small intradural extramedullary mass at the L4 level; the lesion was hypointense on T1-weighted images, hyperintense on T2-weighted images, and homogeneously enhanced with contrast (size: 9 x 12 x 12 mm, occupying 34% of the spinal canal in the axial view) [Figures 1 and 2].
Preoperative computed tomography myelogram. The tumor (arrowheads) is observed to have originated from the left L4 ventral root (yellow arrow), and the dorsal root (white arrow) was compressed by the tumor in the lateral recess.
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F3
T2-weighted MR image [Figure 1b]. The CT myelogram revealed that the tumor had originated from the left L4 ventral root, and contributed to lateral recess compromise [Figure 3].
Intraoperative photographs. (a) The tumor was observed after opening the dura and arachnoid membrane. The tumor (asterisk) markedly compressed the left L4 dorsal root (arrowheads). (b) Tumor resection achieved subtotal resection. The L4 dorsal root was released from the tumor compression. Arrows and arrowheads indicate the L4 ventral and dorsal nerve roots, respectively.
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F4
When a left L3-4 partial laminectomy was performed, the tumor was found to originate from the left L4 ventral root [Figure 4a]. As the tumor capsule was densely adherent to the L4 root, a subtotal tumor resection was accomplished utilizing an ultrasonic surgical aspirator [Figure 4b].