PMC4287902_01
Preoperative sagittal (a) and axial (b) T2-weighted MR showing a 1.7 x 1.4 x 1.6 cm left anterolateral atlantoaxial cyst arising from the left C1-C2 joint and extending towards the left side causing a remarkable cervical cord deformity
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F1
Intraoperative microscopic pictures (a,b) showing the progressive removal of the cyst. Extensive fibrosis is evident around the surgical cavity (b)
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F2
Following a vertical durotomy performed just medial to the C1-C2 joint and using the endoscope to define the cyst versus VA, extensive fibrosis was removed along with the lesion [Figures 2 and 3].
A 0  2.7 mm endoscope was inserted after retraction of the cyst wall to assess the relationship of the cyst with the VA. Endoscopic view was displayed using an image injection system into the microscope oculars
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F3
Following a vertical durotomy performed just medial to the C1-C2 joint and using the endoscope to define the cyst versus VA, extensive fibrosis was removed along with the lesion [Figures 2 and 3].
(a)Two-years follow-up sagittal (a) and axial (b) T2- weighted MR demonstrating neural decompression without lesion recurrence
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F4
The patient's symptoms resolved and he has remained symptom-free for over 30 postoperative months without MR evidence of recurrence or craniocervical instability [Figure 4].