PMC8356230_01
A) Preoperative mid-sagittal CT scan showing OPLL at the L1-L3 levels (arrows) and OLF at the L1-L2 level (arrowheads). B) Preoperative axial CT scan at the L1-L2 level showing OPLL (arrow) and OLF (arrowheads).. CT, computed tomography; OLF, ossification of the ligamentum flavum; OPLL, ossification of the posterior longitudinal ligament
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Preoperative computed tomography revealed ossification of the posterior longitudinal ligament (OPLL) at the L1-L3 levels and ossification of the ligamentum flavum (OLF) at the L1-L2 level (Fig. 1).
A) Preoperative mid-sagittal T2-weighted MRI scan showing an intra-spinal canal space-occupying lesion compressing the cauda equina (arrowheads) at the level of L1-L2, associated with spinal canal stenosis due to OPLL and OLF. B) Preoperative axial STIR MRI scan at the level of the L1-L2 disc showing a heterogeneous high-intensity lesion (arrowhead) nearly compressing the entire spinal canal. C) Preoperative axial STIR MRI scan at the level of the upper L2 endplate showing that the nerve rootlets of the cauda equina (arrows) are laterally pushed to the right and the left sides.. MRI, magnetic resonance imaging; OLF, ossification of the ligamentum flavum; OPLL, ossification of the posterior longitudinal ligament; STIR, short-TI inversion recovery
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Preoperative magnetic resonance imaging (MRI) indicated a space-occupying lesion in the spinal canal at the L1-L2 level (Fig. 2).
A) Intraoperative photograph showing that the lesion is similar to the intradural disc hernia (asterisk) and the tumoral lesion continuous with a cauda equina rootlet (arrowheads). B) Excised specimen of the lesion is similar to the intradural disc hernia. C) Specimen of the parenchyma of the cauda equina tumor excised using the intracapsular enucleation procedure.
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The dural sac was opened posteriorly, where a cauda equina tumor was observed in the dorsal part of the intradural space; a yellowish white mass that appeared like IDH was also seen in the ventral area of the intradural space (Fig. 3A). After removing the intradural yellowish white mass (Fig. 3B), the cauda equina tumor was excised using the intracapsular enucleation procedure (Fig. 3C), and the dura mater was closed posteriorly; we could not perform primary suture of the anterior dural tear because it was determined to be technically difficult, as has been reported previously,).
Hematoxylin and eosin staining of the resected specimen of tumor in the cauda equina. High-power field (200x) reveals the proliferation of spindle cells with mild polymorphism.
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Histopathological examination revealed that the cauda equina tumor was a schwannoma (Fig. 4) and that the yellowish white mass was the nucleus pulposus of the herniated disc.