Low-grade glioma in a 5-year-old patient with neurofibromatosis 1. This low-grade lesion does not enhance on the post-contrast images, but does show an intermediate APT signal. The lesion stability over time confirms that it is a low-grade pathology.
No abnormal findings were seen on routine MRI. Then x-ray radiculography was performed, but the contrast agent became trapped in transit and the nerve could not be fully observed. The peripheral nerve root is not contrasted in the nerve root block (x-ray radiculography) at the suspected location.
NerveVIEW images show that the spinal nerve is discontinued at the periphery of the dorsal root ganglion of the right L5 nerve root, suggesting nerve compression there. No other findings could explain the symptoms. With a diagnosis of extraforaminal herniation, surgery was performed.
Based on the findings using NerveVIEW, the surgeon decided to perform a hernia resection with a different, less invasive surgical approach from the outside of the multifidus muscle (B) instead of the usual approach (A). During surgery, disc herniation outside the intervertebral foramina was confirmed. Hernia resection released pressure on the nerve root and the right lower limb pain disappeared.
Impact of 3D NerveVIEW in this case
MRI on Achieva 3.0T dStream with NerveVIEW shows compression of nerve root outside the right L5/S1. Because NerveVIEW helped to accurately identify the location of the causative disease, a surgical approach could be chosen that prevented the need to peel off the muscle unnecessarily.