PMC7568105_01
(a) Sagittal T1-weighted image of preoperative magnetic resonance imaging (MRI) showing the intradural extramedullary spinal cord tumor anterior to the spinal cord, located from the C4 to C6 level, centered on the C5 level. (b) Sagittal T2-weighted image of the tumor. (c) Axial T2-weighted MRI at the C5 level reveals a large tumor filling the spinal canal, and no boundary with the spinal cord is identifiable. (d) Gadolinium-enhanced sagittal MRI demonstrates a homogeneously enhanced tumor with dural tail sign located anterior to the spinal cord.
SNI-11-317-g001.jpg
PMC7568105_01_SNI-11-317-g001.jpg
F1
The cervical MR imaging demonstrated a large intradural extramedullary anterior tumor at the C4-C6 level that severely compressed the spinal cord [Figure 1a-c]. It homogeneously enhanced with contrast and exhibited the classical dural tail sign [Figure 1d].
(a) Intraoperative photographs after opening the dura. The tumor is seen anterior to the spinal cord. Right side of photographs = cranial side. (b) The tumor is excised little by little after dissecting two denticulate ligaments. (c) After complete tumor resection, the inner layer of dura as the base of the tumor is peeled away from the outer layer of dura. (d) The inner layer of the dura was resected.
SNI-11-317-g002.jpg
PMC7568105_01_SNI-11-317-g002.jpg
F2
The tumor was resected from the right side utilizing the cavitational ultrasonic surgical aspirator [Figure 2a and 2b]. Just the inner dural layer was removed, preserving the outer layer for subsequent watertight dural closure [Figure 2c and 2d].
(a) Postoperative MRI of the cervical spine obtained at 5 years after surgery. Sagittal T2-weighted MRI shows no tumor recurrence with unchanged normal sagittal alignment. (b) Axial T2-weighted MRI at the C5 level shows no tumor recurrence with good visualization inside the spinal canal. (c) Postoperative axial image of computed tomography (CT) at the C4 level demonstrates a newly created spinal canal with hydroxyapatite spacers bonded to host bone. (d) Axial image of CT at C5 level.
SNI-11-317-g003.jpg
PMC7568105_01_SNI-11-317-g003.jpg
F3
The 5-year follow-up MR showed no tumor recurrence (HA spacers avoided metal artifact) and stable spinal alignment [Figure 3a and b]. Further, the 5-year postoperative CT confirmed fusion of the HA spacers [Figure 3c and d].