Dr Deepa Chandran Podcast

An 18-year-old young man arrived with rapidly worsening weakness in
his left leg. His MRI suggested an intramedullary spinal cord
tumor—something that can lead to permanent paralysis if not treated
quickly. He was taken for urgent surgery, and as the
neuroanesthesiologist, my goal was to provide anesthesia that kept him
safe while preserving the accuracy of intraoperative neuromonitoring
(IONM).

Intraoperative Ultrasound: The First Clue

Before the main dissection began, the team performed intraoperative
ultrasound (IOUS). Instead of the solid mass expected from a tumor,
IOUS showed a well-defined, fluid-filled lesion, raising suspicion of
something unusual.
This early imaging helped the surgeons plan a gentler approach from
the start—crucial in such a narrow, fragile space.

Real-Time Neuromonitoring: The Second Warning

Despite careful technique, motor evoked potentials later dropped
suddenly, signaling spinal cord stress. Because the anesthesia was
optimized for neuromonitoring—using TIVA and avoiding muscle
relaxants—the change was unmistakable. The surgeons paused, adjusted
their strategy, and the signals recovered, likely preventing permanent
damage.

A Rare Diagnosis

The lesion was finally removed and confirmed to be neurocysticercosis,
a parasitic cyst from the tapeworm Taenia solium, which can lodge in
the brain or spinal cord. Spinal involvement is rare but dangerous due
to tight space and risk of nerve compression.

A Good Recovery

After surgery and appropriate medical treatment, the young man
gradually regained strength and was able to walk again.

This case shows how neuroanesthesia, neuromonitoring, and
intraoperative ultrasound work together to guide the surgical team,
prevent injury, and change the course of a patient’s
outcome—especially when every second matters.