PMC5054637_01
Magnetic resonance study just before the surgery. (a) T1 sagittal, (b) T1 axial, (c) T2 sagittal, (d) T2 axial weighted images revealing left L4-5 discal cyst
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F1
The original MR study documented a left-sided left L4-5 intervertebral disc compressing the left L5 nerve root [Figure 1].
Magnetic resonance study 6 months before the surgery. (a) T1 sagittal, (b) T1 axial, (c) T2 sagittal, (d) T2 axial weighted images revealing prolapsed left L4-5 disc
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F2
T1 and hyperintense on T2-weighted images, which was consistent with a cyst [Figure 2]. The patient underwent a left-sided L4-5 microsurgical laminotomy for cyst decompression/excision.
(a) Location of the cyst (*) in the nerve root axilla (T: Thecal sac, L: left L5 nerve root.). (b) Removal of the subligamentous disc fragment. (c) Final operative view, showing complete excision of the cyst and indentation on the nerve root by the cyst (arrow)
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F3
During surgery, a small well-encapsulated, grayish blue colored extradural cyst compressing the left L5 root was completely removed [Figure 3a]. The cyst communicated with the subligamentous disc fragment [Figure 3b] and was connected to the intervertebral disc [Figure 3c].
Histopathological findings (Haematoxylin-Eosin x100), showing the cyst wall consisting of dense fibrous connective tissue, along with ligamentous tissue, without any epithelial lining. Hemosiderin deposits were detected in the cyst wall (arrows)
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F4
Hemosiderin deposits were noted in the cyst wall [Figure 4].