• Rami Darwazeh, Hamzah Youssef Smaili, and Martin U Schuhmann.
• Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Tübingen, Germany. Electronic address: rami6600@gmail.com.
• World Neurosurg. 2024 Apr 1; 184: 185187185-187.

AbstractA 14-year-old boy presented with a 2-year history of slowly increasing weakness and atrophy in the right forearm and leg. Magnetic resonance imaging (MRI) revealed an intramedullary diffusely infiltrating lateralized tumor at C3-7. An extended biopsy was planned. After laminotomy and durotomy, the swollen spinal cord was noted to be rotated by 45° with the right dorsal root entry zone being in the midline. A 15 MHz linear ultrasound probe was used to identify the midline by visualizing the dorsal median sulcal vein within the midline raphe. A myelotomy was made in that zone without deterioration of somatosensory evoked potentials (SEPs) and an extended biopsy was performed. Histological examination revealed a pilocytic astrocytoma. Modern intraoperative high-resolution color-coded ultrasound enables the identification of the midline in intramedullary spinal cord lesions even when the spinal cord anatomy is distorted.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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