PMC6744821_01
Cutaneous nodules cafe-au-lait spots.
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F1
On examination, the patient exhibited cutaneous nodules/cafe-au-lait spots scoliosis, and a Grade 4 tetraparesis characterized by diffuse hyperreflexia with bilateral Babinski signs [Figure 1].
(a) Cervical magnetic resonance imaging - T2 with solid nodular expansive lesion originating from the level of C2-C3 (5 cm x 4 cm x 5.1 cm) with extension toward the foramen magnum, causing medullary and bulbar compression and another lesion from the level of C4-C5. (b) Dumbell type formation intradural and extramedullary. (c) Represents an extradural component of C2C3 lesion. (d) Anterolateral lesion of smaller size located anterolateral right.
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F2
It contributed to medullary and bulbar compression [Figure 2].
(a) Intraoperative period showing tumoral lesion after removal of the posterior C1 arch and C2 laminectomy. (b) Electrode placement for somatosensory monitoration intraoperatory. (c) Aseptic technique for surgery beginning.
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F3
Partial removal of the C4-C5 secondary lesion was performed as this was benign, and it allowed for the preservation of stability [Figure 3].
(a) Patient presenting good scarring process after 30 days of the surgery. (b) Postoperatory control computed tomography showing lateral suboccipital approach. (c) Noncontrast magnetic resonance imaging T1 showing regression of the brainstem compression.
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F4
The postoperative magnetic resonance (MR) scan obtained revealed satisfactory resection of both lesions [Figure 4].