Resection of a Thoracic Intradural Extramedullary Cavernoma Using Real-Time Intraoperative Ultrasound: 2-Dimensional Operative Video

Abstract

Spinal cavernomas are rare pathological entities.1-3 Intradural extramedullary cavernomas of the spinal cord are especially rare,with only 71 cases previously described.4 As with cavernous malformations elsewhere in the central nervous system, these lesions are susceptible to spontaneous hemorrhage As such, surgical resection in symptomatic cases is indicated to prevent neurological decline.5 Here, we describe the case of a 55-year-old female patient with 1 year of back pain and bilateral lower extremity numbness who presented acutely with diminished leg strength MRI revealed an intradural extramedullary mass at the T11-12 level with a fluid-level concerning for hemorrhage During surgery real-Time intraoperative ultrasound (IOUS) was used to verify adequate bony decompression and toevaluate themorphologyof the lesion in relation to thespinal cordbefore durotomy.We performed biopsy and gross total resection of themass on the dorsal root entry zone at T11-12 on the right side using a microsurgical technique After resection, IOUS supplemented gross visual inspection to confirm the absence of any residual lesion Pathology was consistent with a cavernous malformation Disease background and operative details with microsurgical and ultrasound footage are presented Postoperative MRI showed complete decompression of the spinal cord and no residual enhancing lesion at the T11-12 levels The patient tolerated the procedure well with improvement in her neurological examination at discharge and with continued improvement in ambulation at 6-month follow-up.The patient consented to participate in the surgery and surgical video.