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 ).