• William T Couldwell, Meic H Schmidt, and Vance Mortimer.
• Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. Electronic address: neuropub@hsc.utah.edu.
• World Neurosurg. 2020 Jun 1; 138: 200.

AbstractThis Video 1 presents the surgical management of a 36-year-old woman who presented with progressive weakness in her right arm associated with a pins-and-needles sensation. Magnetic resonance imaging of the cervical spine revealed a likely hemorrhagic cavernous malformation of the spinal cord at the C3-4 level. The lesion was wholly intramedullary with no presentation to the surface of the spinal cord. It was located in the spinal cord centrally with some right-side predominance. Treatment options were presented to the patient, who agreed to surgery. A resection was performed after a hemilaminotomy at C3 and C4 levels. A biportal technique was used, demonstrating resection of the malformation through 2 small myelotomies made between the entering rootlets at the dorsal root entry zone. This was intended to preserve all roots at the entry zone while enabling visualization of the entire cavernous malformation and its cavity from 2 different portals of entry, essentially providing the same field of access while preserving all roots. After successful resection, the cavity was carefully inspected and closure of the dura was performed, followed by fixation of the osteotomy sites of the laminae at C3 and C4. The patient awoke with no new neurologic deficits and has had no evidence of lesion recurrence or symptoms in 3-year follow-up. The patient provided consent for publication.Copyright © 2020 Elsevier Inc. All rights reserved.

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