Plexiform neurofibroma of the cauda equina with follow-up of 10 years: A case report

Figure 1 Contrast-enhanced magnetic resonance imaging (T2-weighted imaging sequence) performed in 2010 revealed a non-enhancing intradural tumor extending throughout the Th12-L4 vertebral levels. A: Sagittal plane: a non-enhancing intradural tumor extending throughout the Th12-L4 vertebral levels; B: Axial plane. Tumor at the level of L1 vertebral body. Note few enlarged lumbar nerve roots engulfing conus medullaris.

Figure 2 Intraoperative photograph demonstrating the enlarged nerve root which emerged immediately following the duratomy.

Figure 3 The histological appearance of the pathological specimen, final diagnosis was consistent with plexiform neurofibroma. A: 10 ×-magnified hematoxylin-eosin staining (H&E) micrograph: note the preserved gross architecture of the nerve and coagulated resection margin; B: 40 ×-magnified H&E micrograph. Appearance of hypocellular tumor consisting of Schwann cells with wavy contours and elongated nuclei with fine dense chromatin, fibroblasts, and mast cells. No signs of atypia were observed.

Figure 4 Subsequent magnetic resonance imaging (T2-weighted imaging sequence) control performed in 2015, midsagittal plane. Note the slight increase in tumor mass over the 5 years following the initial surgery. Neoplastic expansion is accommodated by bony decompression and duraplasty.

Figure 5 Magnetic resonance imaging (T2-weighted imaging sequence) performed in 2018. A: Sagittal plane. Note markedly enlarged tumorous masses occupying the majority of the spinal canal, with a most significant stenosis at L3-L4 segment; B: Axial plane at L4 vertebral body level. Instability-induced ligamenta flava and facet joints (not seen in the section) hypertrophy, resulting in lumbar spinal stenosis at L3-L4 Level.

Figure 6 The magnetic resonance imaging (T2-weighted imaging sequence) performed in 2020 following the second surgery involving L4-L5 Laminectomy and L2-L5 transpedicular fixation. A: Sagittal plane. Position of titanium screws following the transpedicular fixation. Titanium-induced artefacts prevent from reliable evaluation of the spinal canal and its contents; B: Axial plane at L3-L4 segment level. Note the additional space available in the central canal following the extended decompression.