• Krisztina Moldovan, Sanjay Konakondla, Sean M Barber, Jonathan Nakhla, Jared S Fridley, Albert E Telfeian, Ziya L Gokaslan, and Adetokunbo A Oyelese.
• Warren Alpert Medical School of Brown University, Department of Neurosurgery and Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, Rhode Island, USA.
• World Neurosurg. 2019 Sep 1; 129: 311-317.

BackgroundIntramedullary spinal cord cavernous malformations (ISCCMs) are a rare entity. Most commonly, ISCCMs present with neurologic decline from lesion hemorrhage, which can be catastrophic and irreversible irrespective of surgical intervention. Given the challenging anatomic location of these lesions in highly critical neurologic areas, precise surgical localization and visualization is necessary to limit collateral damage during resection particularly for deep ISCCMs that do not present to a pial surface.Case DescriptionWe present a case of a 54-year-old man who presented with incomplete paraplegia after hemorrhage of a deep ISCCM at T11. Surgical resection was undertaken using intraoperative computed tomography (CT) navigation assistance autofused with high-resolution preoperative magnetic resonance imaging for precise intramedullary lesion targeting and localization for myelotomy. Complete resection was demonstrated on postoperative imaging. At a 6-week follow-up appointment, the patient endorsed return of his bladder function and was noted to have some return of motor function to his left foot with 3 of 5 dorsiflexion. At 4 months, he had improved to 3 of 5 proximal, 4 of 5 distal on the left and 2 of 5 proximal, and 3 of 5 distal on the right.ConclusionsThe approach represents a novel application of intraoperative CT navigation assistance in the resection of deep ISCCMs.Copyright © 2019 Elsevier Inc. All rights reserved.

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