C5-C6 Cervical Spinal Cord Cavernous Malformation Microsurgical Resection: 2-Dimensional Operative Video

We describe the case of a previously healthy 44-yr-old female patient presenting with a sudden onset of numbness, paresthesias, and decreased sensation in her lower limbs. Physical examination revealed a decreased sensation to vibration and light touch in her lower extremities, primarily in the left limb. Impaired proprioception was also evident primarily in the left toe. Full strength with 2+ reflexes was observed in all extremities. Magnetic resonance imaging demonstrated an exophytic lesion in the posterior aspect of the cervical spinal cord at the C5-C6 level, with a hemosiderin halo, consistent with a cavernous malformation. Given the evidence of past hemorrhage and the location of the lesion, microsurgical intervention was indicated. A midline cervical C5-C6 laminectomy under neurophysiologic monitoring was performed, and complete resection of the lesion was achieved with mild improvement of the sensitive symptoms and no evidence of new motor deficits. Any microsurgical resection of a cervical spinal cord lesion can be technically difficult and adequate patient selection with evaluation of the accessibility to the lesion is key.1 Surgical resection of cavernous malformations in selected patients eliminates the risk of future hemorrhage and may achieve satisfactory outcomes comparable to patients who undergo conservative management.2 In the following video illustration, we narrate this operative case, and highlight the nuances of this approach. Patient consent was obtained for the submission of the video to this journal.