PMC3267373_01
Magnetic resonance images: Preoperative T2-weighted MRI. (a) Axial and (b) sagittal images reveal a right L3-L4 extradural foraminal dumbbell-shaped mass with extraforaminal extension into the right psoas muscle. The patient underwent minimally invasive resection. Postoperative T2-weighted MRI. (c) Axial and (d) sagittal images demonstrate gross total resection and postoperative changes
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F1
Magnetic Resonance imaging (MRI) scan revealed a large dumbbell-shaped extradural foraminal lesion at the L3-L4 level with significant extraforaminal extension [Figure 1a and b]. Postoperative MRI showed no residual tumor [Figure 1c and d].
Intraoperative fluoroscopy: (a) AP and (b) lateral X-rays confirm adequate placement of the tubular retractor in between the L3 and L4 spinous process lateral to the L3-L4 facet complex
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F2
Fluoroscopy confirmed the adequate position of the tube retractor in between the right transverse processes of L3 and L4, just lateral to right L3-L4 facet complex [Figure 2].
Illustration depicting resection of the giant extraforaminal schwannoma through a minimally invasive transmuscular tube retractor placed lateral to the facet complex
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F3
Following coagulation of the tumor capsule, intracapsular debulking was performed using cavitron ultrasonic surgical aspirator (CUSA) [Figure 3].