4-year-old male status post chiari decompression January 2016 with syrinx. BRAIN: Postsurgical changes of the posterior suboccipital craniectomy compatible with a Chiari decompression and left cerebellar tonsillar resection. There is now ample CSF space in the neo-foramen magnum. There is now biphasic CSF flow across the ventral and dorsal aspect of the neo-foramen magnum, as well as along the dorsal upper cervical canal.There is no evidence of intracranial hemorrhage, mass, or acute infarct. Focus of asymmetric T2/FLAIR signal abnormality in the periventricular white matter along the posterior body the right lateral ventricle region of the right lateral ventricle, in the area of a terminal zone of myelination, may represent asymmetric variation of myelination versus more likely gliosis given the possible mild volume loss. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.CERVICAL SPINE: A syrinx is noted at the C5-C7 levels slightly decreased craniocaudal extent now measuring 1.5 cm and measuring 3 mm in AP dimension, previously 8 mm AP. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE: Trace residual prominence of the central spinal canal is noted at the T8 level measuring 1.0 mm in diameter, significantly improved since the prior exam, where the thoracic syringohydromyelia was only partially visualized.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is otherwise of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.
1.Expected postoperative changes following Chiari decompression, with patent neoforamen magnum and restoration of dorsal biphasic CSF flow at this level.2.Interval decrease in size and craniocaudal extent of a cervical spine syrinx.3.Significant interval improvement of previously partially visualized lower thoracic syringohydromyelia, with trace prominence of the canal at the T8 level.