PMC5949157_01
T1- and T2-weighted images from noncontrast magnetic resonance imaging: a mass is seen at the L1-2 level (arrow) with a low intensity on T1-weighted imaging (a) and a slightly high intensity on the T2-weighted image (b). The axial views demonstrate the mass occupying the right side of the spinal canal (arrow).
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An axial slice showed that the mass occupied the right side of the spinal canal (Figure 1), but it was unclear whether it was located in the extradural or intradural space.
Computed tomographic myelography demonstrates the mass located in the right side of the intradural space, significantly compressing the cauda equina (arrow).
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CT myelography clearly revealed that the mass was intradural and was compressing the cauda equina nerve rootlets (Figure 2).
Contrast-enhanced magnetic resonance imaging: T1-weighted images show a peripheral rim enhancement of the intradural lesion (arrow).
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On contrast-enhanced MRI, T1-weighted images showed a rim enhancement of the mass (Figure 3).
(a) On dorsal dural incision, a mass is observed between the nerve rootlets. (b) A dissector and sucker were used to carefully peel the adherent nerve rootlets away from the disk fragment. (c) The disk fragment was resected by the piecemeal technique. (d) A round defect of the ventral dura and a tear in the disk annulus are shown. The dural tissue around the defect is thickened (arrow). (e) The tear in the annulus was confirmed by inserting the tip of bipolar forceps into the tear. (f) After trimming the thickened margin, the dural defect was repaired using nylon sutures.
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After dorsal dural incision was performed, we found a yellowish, rubbery, solid mass which was adherent to the cauda equina nerve roots within the subarachnoid space (Figure 4(a)). The nerve roots adhering to the fragment were carefully dissected using a dissector and sucker (Figure 4(b)), and the fragment was resected by the piecemeal technique (Figure 4(c)). We found a smooth and round defect of the ventral dura and a tear in the disk annulus (Figures 4(d) and 4(e)). After trimming the thickened margin around the defect, we closed it using nylon sutures (Figure 4(f)).