Figure 1: A, B, & C: The MRI images of the thoracic spine. A) Coronal T1-weighted MRI image shows a ring-like enhancing intradural lesion after gadolinium. B) Sagittal T1-weighted MRI image shows a 2.1 X1.7 X 1.45 cm intradural/juxta medullary and extramedullary mass with central necrosis and marginal enhancement after gadolinium suggestive of immature tuberculoma at T5 level. C) Axial T2-weighted image.
No evidence of vertebral TB, spinal tract infiltration, or engulfment was noted. A diagnosis of D5 Intra-dural extra medullary space-occupying lesion (SOL) with spastic paresis, cord compression, compressive myelopathy, disseminated tuberculosis, and post-tuberculous medication-induced hepatic granuloma was made. D4-D6 laminectomy and microsurgical excision under IONM was planned to remove the lesion. After pre-anesthetic assessment and consent, the patient underwent the procedure with the head held in a horseshoe, subperiosteal muscle dissection made, and laminae exposed. Durotomy was performed under a microscope and the lesion was visualized. A grayish-white, firm lesion with a central necrotic area was exposed (Figure 2 ).