Follow-up regarding Chiari malformation and syringomyelia, which were decompressed in September 2011, including a vascularized rotational muscle flap at the same procedure to obliterate the extradural dead space and chronic pseudomeningocele. The patient had had a previous resection of a giant spinal intradural and extradural schwannoma involving the C1-C2 area in 2008, and there had not been any hint of residual or recurrent tumor. There are chronic postoperative findings related to Chiari malformation surgery. There is an unchanged syrinx in the upper cervical spinal cord that measures 5 x 14 mm in axial cross-section. There is also an unchanged 1 mm linear band of T2 hyperintensity in the left hemicord that extends inferiorly from the syrinx to the level of C5. There is intact cerebrospinal fluid flow across the anterior neo-foramen magnum, but deficient flow posteriorly. There is an unchanged prominent extra-axial cerebrospinal fluid space that spans the posterior neo-foramen magnum associated with deformity of the adjacent upper spinal cord and medulla. There is no evidence of intraspinal mass lesions. The paraspinal and occipital scalp soft tissue are unchanged and there is no evidence of pseudomeningocele. The vertebral body heights and alignments are intact. There is an unchanged multilevel degenerative cervical spondylosis that is most pronounced at C3-4, where a posterior disc-osteophyte complex results in mild spinal canal narrowing and mild to moderate right neural foraminal narrowing.
1. Post-treatment findings related to Chiari malformation surgery with an unchanged upper cervical syrinx, adjacent left hemicord myelomalacia, and what appears to be encysted cerebrospinal fluid spanning the posterior neo-foramen magnum, perhaps due to adhesions.2. No evidence of recurrent cervical spine schwannoma.3. Unchanged multilevel degenerative cervical spondylosis that is most pronounced at C3-4, where a posterior disc-osteophyte complex results in mild spinal canal narrowing and mild to moderate right neural foraminal narrowing. 