PMC10277559_01
Pre-operative MRI and MRA. (A) Timeline of relevant surgical treatments undergone by the patients described in this case. Green labels indicate events during this episode of care. (B) Sagittal MRI-section of the thoracic spinal cord (T1-weighted FLAIR after gadolinium). (C) Axial MRI-slices (T1-weighted FSE after gadolinium) of lesion 1 at T10 (yellow asterix) and lesion 2 at T11 (green asterixis). (D) MRA of the full spinal cord. (E) Zoom in on the MRA of both lesions. HB, Hemangioblastoma; R, Right; T1-w, T1-weighted; gd, gadolinium; MRA, Magnetic Resonance Angiography.
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F1
Th12-L3) and one procedure to remove a high cervical, intramedullary hemangioblastoma (Figure 1A). This surgery was complicated by neurological deterioration. The largest (lesion 1) appeared to be both intra- and extramedullary and was located at Th10-Th11 on the right posterior side of the myelum (1.0 cm x 1.4 cm x 2.2 cm, Figures 1B-C), causing myelum compression. MRA (Figure 1D) did not show hypertrophy of the radiculary artery or dural fistuling. Prominent, probably venous vessels were seen directly caudal from lesion 1, suspected to be formed after local hemodynamic changes due to compression and/or congestion (Figure 1E).
PMC10277559_02
Intra-operative experimental acquisition of microDoppler-images. (A) Our custom CUBE-cart integrated into the conventional neurosurgical OR. (B) Example of a hand-held acquisition along a continuous trajectory. (C) Our intra-operative surgical arm used to stabilize the probe of ROI. (D) Microscopic view of the spinal cord after opening the dura.
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F2
First, hand-held 2D-images were made along a continuous trajectory spanning the full axial and sagittal length of the exposed myelum (Figure 2B) for orientation purposes. Next, stable acquisitions of 30 s were made by placing the probe over a ROI using a modified intra-operative surgical arm (Trimano, Gettinge) with a transducer-holder (Figure 2C). After the first HFR-acquisitions, the dura was opened (Figure 2D).
PMC10277559_03
Intra-operative experimental acquisition of microDoppler-images. (A) Our custom CUBE-cart integrated into the conventional neurosurgical OR. (B) Example of a hand-held acquisition along a continuous trajectory. (C) Our intra-operative surgical arm used to stabilize the probe of ROI. (D) Microscopic view of the spinal cord after opening the dura.
fsurg-10-1153605-g002.jpg
PMC10277559_03_fsurg-10-1153605-g002.jpg
F2
First, hand-held 2D-images were made along a continuous trajectory spanning the full axial and sagittal length of the exposed myelum (Figure 2B) for orientation purposes. Next, stable acquisitions of 30 s were made by placing the probe over a ROI using a modified intra-operative surgical arm (Trimano, Gettinge) with a transducer-holder (Figure 2C). After the first HFR-acquisitions, the dura was opened (Figure 2D).