case_images: PMC10849788_01
case_images: Preoperative imaging. (A-F) MRI and CT scan during diagnostic assessment. Sagittal T1 and T2 (A-B) images show the crucial path of the lesion (red arrow) identified from the skin to the spinal cord. Note the dermal sinus extending cranially from the opening lesion. Tethering causes a dorsal displacement of the cord and syringomyelia (dotted red arrow). (C-D) Axial T2 imaging demonstrates the tract crossing all skin layers heading to the spinal cord (red arrows). CT scan (E-F) displayed the conduit trajectory in the sagittal bone window (arrow and dotted line). Coronal CT scan with three-dimensional reconstruction (F); posterior view showing dysraphism of the spinous process and posterior arch of C4 (red arrow). C3 and C5 exhibit dysraphism with small spinous processes and notches allowing abnormal tract continuity.
case_images: cureus-0016-00000051883-i01.jpg
case_images: PMC10849788_01_cureus-0016-00000051883-i01.jpg
case_images: FIG1
case_images: T1 and T2 sequences demonstrated an isointense and hyperintense lesion, respectively (Figure 1). CT scan showed a dysraphism corresponding to spina bifida at the C4 level and an incomplete closure at the C3 and C5 vertebrae (Figure 1).
case_images: Intraoperative imaging and surgical approach. (A-F) Gross imaging and fluoroscopy during surgical resection. (A) The tract was followed from the skin to its intradural location without losing the main trajectory (red arrow). (B) Muscle layer trajectory. Although we identified the tract, laminectomy of C3, C4, and C5 was performed to continue a wide and safe exploration (white arrow). (C) Intraoperative view showing posterior cervical instrumentation of C3, C4, and C5 (white arrow). (D) Gross examination of the 5 cm specimen showed a 3 mm diameter lumen of the tract (red arrow). (E) Post-closure capture with reference to the midline (black arrow). (F) Lateral fluoroscopy imaging. Posterior cervical fusion was performed due to multiple cervical vertebrae dysraphism, which prevented performing laminotomy.
case_images: cureus-0016-00000051883-i02.jpg
case_images: PMC10849788_01_cureus-0016-00000051883-i02.jpg
case_images: FIG2