case_images: PMC7193206_01
case_images: Pre-operative T2-weighted MRI sagittal (a) and axial (b) images show a "hawk-beak like" appearance at L1-L2 level, suspecting an intradural herniated disc (yellow asterisk).
case_images: SNI-11-67-g001.jpg
case_images: PMC7193206_01_SNI-11-67-g001.jpg
case_images: F1
case_images: The lesion itself at L1-L2 did not enhance with contrast, but there was enhancement of the surroundings tissues [Figure 1].
case_images: Intraoperative description of the IDH removal. After the L1-L2 laminectomy, a dural incision is made. The roots of the cauda equina (black arrow) appear dislocated by a voluminous migrated intradural disc fragment. (black asterisk) (a) With the use of disc pounches a removal of the voluminous IDH is performed. (b) Microsurgical discectomy is completed with the use of a Cushing's buttoned nerve hook (black asterisk) through the ventral dural defect (c), achieving a macroscopic complete disc removal and decompression of the nerve roots (black arrow). (d).
case_images: SNI-11-67-g002.jpg
case_images: PMC7193206_01_SNI-11-67-g002.jpg
case_images: F2
case_images: This was carefully teased away under the operating microscope from the surrounding nerve roots of the cauda equina and ventral dura [Figure 2].
case_images: Post-operative T2-weighted MRI sagittal (a) and axial (b) images show an optimal decompression of the conus medullaris and of the roots of the cauda equina with absence of further disc fragments.
case_images: SNI-11-67-g003.jpg
case_images: PMC7193206_01_SNI-11-67-g003.jpg
case_images: F3
case_images: One week postoperatively, the lumbar MR confirmed adequate decompression of the spinal canal without any residual disc [Figure 3].