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Figure 1: Preoperative, postoperative, and intraoperative images of the case. (a) The lamina that covered the posterior sacrum appeared to have been thinned in the preoperative axial computed tomography image. Foramina in the sacrum appeared to be regularly wider and greater than the normal, based on the diffuse growth of the nerve roots. (b and c) A mass was visible in the computed tomography image, extending from the neural foramina of the sacral spinal area into the presacral area. The pelvic computed tomography showed an occlusion defect toward posterior at the sacral level and large-scale expanded nodular mass lesions in the neural foramina. After the surgical decompression, the sacrum lamina was not observed in the area marked with red arrows. (e-j) in the postoperative magnetic resonance, a mass lesion was visible, extending from the neural foramina of the sacral spinal area into the presacral area. (d) A mass lesion was visible on the sagittal T2-magnetic resonance image. (e) On the sagittal T2-magnetic resonance image, a mass extending from the neural foramina of the sacral spinal area to the presacral area was visible, which was expanding toward the posterior and upwardly following the surgery. (f) In the turbo-spin-echo sequence, the lumbar spinal S1 root appeared to be quite large. (g) The right S2 sacral spinal nerve root was visible on the axial T2-magnetic resonance image section. (h) After the removal of sacrum lamina, the sacral nerve roots appeared to have shifted posteriorly. Because a piece of the S2 nerve root was extracted to get the true diagnosis, the right S2 nerve root was not visible. (i) The lesion appeared to have no contrast on the contrast-enhanced T1-magnetic resonance image section. (j) In surgical view, the right S2 nerve root appeared to have diffusely grown in every direction

Figure 1: Preoperative, postoperative, and intraoperative images of the case. (a) The lamina that covered the posterior sacrum appeared to have been thinned in the preoperative axial computed tomography image. Foramina in the sacrum appeared to be regularly wider and greater than the normal, based on the diffuse growth of the nerve roots. (b and c) A mass was visible in the computed tomography image, extending from the neural foramina of the sacral spinal area into the presacral area. The pelvic computed tomography showed an occlusion defect toward posterior at the sacral level and large-scale expanded nodular mass lesions in the neural foramina. After the surgical decompression, the sacrum lamina was not observed in the area marked with red arrows. (e-j) in the postoperative magnetic resonance, a mass lesion was visible, extending from the neural foramina of the sacral spinal area into the presacral area. (d) A mass lesion was visible on the sagittal T2-magnetic resonance image. (e) On the sagittal T2-magnetic resonance image, a mass extending from the neural foramina of the sacral spinal area to the presacral area was visible, which was expanding toward the posterior and upwardly following the surgery. (f) In the turbo-spin-echo sequence, the lumbar spinal S1 root appeared to be quite large. (g) The right S2 sacral spinal nerve root was visible on the axial T2-magnetic resonance image section. (h) After the removal of sacrum lamina, the sacral nerve roots appeared to have shifted posteriorly. Because a piece of the S2 nerve root was extracted to get the true diagnosis, the right S2 nerve root was not visible. (i) The lesion appeared to have no contrast on the contrast-enhanced T1-magnetic resonance image section. (j) In surgical view, the right S2 nerve root appeared to have diffusely grown in every direction