PMC8769457_01
Preoperative MRI. (A) Sagittal STIR T2-weighted and (B) sagittal T1-weighted post-gadolinium sequences showing an intra-dural extramedullary mass displacing anteriorly the conus medullaris. The lesion appears inhomogeneously hyperintense in STIR T2, with areas of reduced signal representing hemorrhagic components (arrowhead in A), and patchy enhancement after contrast medium administration (white arrows in B). (C) Axial T2-weighted, (D) axial T2*-weighted and E axial T1-weighted post-gadolinium sequences show the mass enlarging the vertebral canal and shifting on the left side the spinal cord. The hemorrhagic portion (arrowhead) is better depicted in the sequence susceptible to paramagnetic effect (more evident loss of signal due to deoxyhemoglobin in D), and is surrounded by a thin area of T2 hyperintensity (white arrows in C and D) with patchy contrast enhancement (white arrows in E). MRI: magnetic resonance imaging, STIR: short time inversion recovery.
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T1 to L2 vertebral level. The lesion appeared heterogeneously hyperintense on T2-weighted and hypointense on T2*-weighted gradient echo; the mass demonstrated patchy enhancement after contrast medium administration (Figs. 1A-1E). The lesion was considered intradural and extramedullary since it caused a left ward deviation of the spinal cord.
Scheme of the lesion: Surgical approach: decompressive T11-L1 laminectomy and exposure of an extremely swollen dural sac, with ectatic vessels around (A-C). The mass presented intratumoral hemorrhage and displaced the roots of the cauda equina (D). Neoplastic spindle-cells, ectatic vessels, and diffuse intertumoral hemorrhage with hematoxylin-eosin (E).
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T11-L1 laminectomy, exposing the dural sac (Figs. 2A-2C), which was extremely swollen, with ectatic vessels around. The dura was opened applying microsurgical technique and a large brownish mass was detected inside the roots of the cauda equina (Fig. 2D). The mass was attached to an ectatic vessel perforating the dura mater. Medium to large caliber ectatic vessels surrounded by extensive hemorrhage were present through the tumor (Fig. 2E).
Postoperative MRI. (A) Sagittal T2-weighted and (B) sagittal and T2-weighted (B) MRI showing the complete removal of the mass. The distal portion of the cord and conus medullaris, previously displaced, reveal mild swelling with T2 hyperintensity (A). MRI: magnetic resonance imaging.
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Postoperative MRI showed that the lesion was completely removed, without surgical complications (Fig. 3).