case_images: PMC9948511_01
case_images: Preoperative MRI of the cervical spine with mid-sagittal view (A) and selected axial T2-weighted images at C3/4 (B), C4/5 (C) and C5/6 (D), demonstrating dorsal tethering of the cervical spinal cord to the overlying dura from approximately C3 to C7. There is eccentricity of the tethering to the left side, as well as a large central syrinx with marked atrophy of the cord.
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case_images: FIG1
case_images: Magnetic resonance imaging (Figures 1A-1D) and CT myelogram (Figures 2A-2C) of the cervical spine demonstrated a severely distorted and atrophic spinal cord from the C4 to C6 levels.
case_images: CT myelogram of the cervical spine with mid-sagittal view demonstrating a posterior laminectomy from C2 to C7 (A) and selected axial images at C3/C4 (B), and C4/C5 (C) with multiple areas of dorsal tethering of the spinal cord, as well as obstruction of CSF flow ventral to the cord, suggestive of an arachnoid cyst. Scatter is occurring due to numerous retained vascular clips from previous surgical interventions.
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case_images: PMC9948511_01_cureus-0015-00000034137-i02.jpg
case_images: FIG2
case_images: Magnetic resonance imaging (Figures 1A-1D) and CT myelogram (Figures 2A-2C) of the cervical spine demonstrated a severely distorted and atrophic spinal cord from the C4 to C6 levels.
case_images: Intraoperative photograph of dural placode . * dural placode
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case_images: PMC9948511_01_cureus-0015-00000034137-i03.jpg
case_images: FIG3
case_images: The free dorsal edge of the adherent dura was identified and gently cut away from the underlying spinal cord leaving a central area consisting of a "dural placode" that could not be safely removed from the spinal cord (Figure 3).
case_images: (A) Intraoperative photograph of the "Billowing Duraplasty" being sutured in place. (B) The completed sutured duraplasty.. * represents allograft. ** represents the underlying adherent placode. Black dot shows completed sutured duraplasty
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case_images: PMC9948511_01_cureus-0015-00000034137-i04.jpg
case_images: FIG4
case_images: Prolene suture (Figures 4A, 4B). Prior to completing the duraplasty, the intradural space was insufflated with warm saline to create a "billowing" effect.
case_images: Postoperative MRI of the cervical spine with mid-sagittal (A) and selected axial T2-weighted images at C3/4 (B), C4/5 (C) and C5/6 (D) demonstrating a more ventral position of the cord compared to the preoperative imaging studies, and restoration of space and CSF fluid volume within the dorsal cistern. There is increased space between the spinal cord and the reconstructed dura, which has been facilitated by the "billowing duraplasty." Note the presence of the retained, adherent dural placode on the dorsal aspect of the spinal cord, represented by the region of low signal on the T2-weighted images, best seen on the mid-sagittal slice.
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case_images: PMC9948511_01_cureus-0015-00000034137-i05.jpg
case_images: FIG5
case_images: A post-surgical MRI study was performed to evaluate the quality of the detethering and evaluate the degree of restoration of the dorsal CSF cistern (Figures 5A-5D).