A 53-year-old male presented with pain and impotence in both lower limbs, numbness of the face with paresthesias, and difficulty walking in the last weeks.
Symptoms partially relieved at bedtime and did not worsen when sitting.
The predominant symptomatology was mental illness, with intense pain in the lower limbs.
Pain increased with Valsalva maneuvers and suffered cyclic worsening.
The whole picture began in September 2002, a year before being seen in Neurosurgery consultation.
The patient reported back pain and bilateral inguinal hernia surgery for years under general anesthesia as the only antecedent.
Magnetic Resonance Imaging revealed a polylobulated, intraspinal, extradural collection compressing the dural sac in 90% of its volume.
Radiologists reported L2-L3 synovial cyst.
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Spinal angiography was not performed, but neither MRI nor surgical procedure revealed any vascular malformations.
Intervention
Laminectomy was performed from L4 to L2.
In L3 and L2, fragments of bone and cartilaginous tissue infiltrated by dark liquid are obtained, which also leaks into the operating field with a similar aspect to fuel-fuel.
Tissue is removed from the area where the dural sac is fixed and the incision is closed.
Pathological anatomy
The report of Pathological Anatomy describes both extemporaneous and postoperative samples as osteocartilaginous tissue, muscle and fibrous tissue, with areas of hemorrhage and macrophages in the periphery hemosided pigment loaded.
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No other type of lesions or malignant cells or malformations are observed.
Postoperative result
Postoperative recovery was excellent without complications and total improvement of symptoms.
After one year of follow-up, the patient remains totally asymptomatic.
