PMC9899479_01
T2-weighted sagittal (a) and axial (c) images of the lumbar spine show a hyperintense intradural mass at L1 (arrow) and severe lumbar canal stenosis due to the degenerative change at L2/3 (arrow head). Post contrast T1-weighted sagittal image (b) shows no enhancement in the mass.
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F1
The T2- MR showed severe stenosis at the L2/3 level due to degenerative changes along with a cephalad L1 hyperintense mass that did not enhance with contrast [Figures 1a and b]. Notably, the conus was displaced ventrally/to the left and the cauda equina was difficult to identify [Figure 1c].
A still image from the operative video shows congested and swollen cauda equina herniating out from the dural opening. Duraplasty with a Gore-Tex membrane was required to close the dura (a). Postoperative T2-weighted sagittal (b) and axial (c) images of the lumbar spine show disappearance of the hyperintense mass lesion.
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F2
At surgery, a diffusely congested, swollen, and tortuous cauda equina herniated through the L1 durotomy; no accompanying cerebrospinal fluid was evident [Figure 2a]. The 3-month follow-up MRI showed no residual mass, but a residual, somewhat clumped, cauda equina at the L1 level [Figures 2b and c].