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Dorsal epidural migration of an extruded disc fragment is an infrequent event, especially in the thoracic spine. An uncommon case involving a 55-year-old man is presented, with a 1-month history of paraparesis and thoracolumbar pain. Magnetic resonance imaging demonstrated a dorsally located, extramedullary mass at the T10-T11 intervertebral level. The lesion was suspected to be a tumor. The patient underwent a T10-T11 laminectomy. Intraoperatively, an encapsulated mass of soft tissue adherent to the dural sac was found. The pathologic diagnosis was inflammatory tissue and disc material. Six months after the operation, the patient remained asymptomatic, and radiologic control showed no residual mass. Although rare, a sequestered disc fragment should be included in the differential diagnosis of an enhancing posterior extramedullary thoracic mass. Preoperative diagnosis of such pathology is difficult because the clinical signs and radiologic images may not entirely exclude other more common thoracic spinal lesions, especially tumors.

Neoplasms that primarily originate from the septum pellucidum are extremely rare. Generally the septum pellucidum is involved in direct extension of tumors that arise from the neighboring structures, principally the corpus callosum. Endoscope-assisted techniques form a useful adjunct to common microsurgical procedures to completely remove intraventricular lesions. There are two main advantages of endoscope-assisted surgery over common microsurgical techniques: reduction of superficial brain retraction with less iatrogenic trauma to the neighboring structures and inspection of hidden corners depict simultaneously anatomical details which are not precisely visible in the zoomed and thus light-reduced beam of the microscope. Four patients with septum pellucidum tumors underwent surgery by a transcallosal approach. In all four patients the endoscope-assisted microsurgery technique was used to remove the tumor. In one of the four patients neuronavigation was additionally used for guidance. Complete tumor excision was achieved in all patients. The histological findings showed pilocytic astrocytoma in two cases, one subependymoma and one neurocytoma, respectively. There were no postoperative complications. Endoscope-assisted microsurgery provides maximum efficiency to remove the septum pellucidum tumors with minimum invasiveness.

The results of the present study augment the current knowledge on the morphology of key anatomical landmarks, CCF, and CCL ossification in the sellar area, indicating population differences. A significant side asymmetry in caroticoclinoid osseous bridging and foramina is highlighted. These findings are necessary for a safe surgical access to the clinoidal area.

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