PMC3437270_01
(a) Computed tomography (CT) scan showing a tumor occupying the spinal canal and extending into the paravertebral space through the right intervertebral foramen between Th7 and Th8. Axial (b) and coronal (c) T1-weighted magnetic resonance images with gadolinium enhancement, revealing a well-demarcated enhancing dumbbell-shaped tumor at Th7/8 on the right side. The tumor compresses the spinal cord anterolaterally towards the left side.
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A computed tomography (CT) scan demonstrated a thoracic epidural tumor occupying the spinal canal and extending into the right paravertebral space through the intervertebral foramen between Th7 and Th8 (Figure 1(a)). Coronal magnetic resonance (MR) imaging showed a hyperintense tumor on the T2-weighted image at Th7 (Figure 1(b)). Axial MR imaging showed that the thoracic cord was markedly compressed on the right side and that there was cystic degeneration of the extracanalicular portion (Figure 1(c)).
Intraoperative photographs demonstrating the intrathoracic (a) and intrapleural region (b). The extradural tumor was exposed by right unilateral hemilaminectomy (a). The decompressed tumor was identified, and the parietal pleura overlying the tumor were divided (b).
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Th7 and Th8 transverse process (Figure 2(a)). The tumor was located extradurally, and internal decompression was performed with minimum retraction to the dural sac wherever possible. The intra- and extracanalicular portions of the tumor were connected by a narrow stalk through the foramen. The intracanalicular portion of the tumor was carefully separated, and the fluid within the extracanalicular portion was drained. Once the tumor was identified, the parietal pleura overlaying the tumor were divided to allow the tumor to be dissected free from the vertebra (Figure 2(b)).
Photomicrograph reveals spindle-shaped tumor cells with "palisades," which is compatible with the diagnosis of neurinoma (a) x40; hematoxylin and eosin, (b) x200; hematoxylin and eosin.
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Pathological examination demonstrated bundles of the spindle-shaped tumor cells arranged with typical feature of palisading containing degenerative tissue and deposition of hemosiderin (Figure 3).
Postoperative hemilaminectomy of CT scan (a), axial (b), and coronal (c) views of T1-weighted MR images with gadolinium enhancement demonstrating complete removal of the tumor and decompression of the thoracic cord.
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Follow-up CT scan and MR imaging confirmed total removal of the tumor, and her symptoms had completely resolved (Figure 4).