History of lumbar lipomyelomeningocele repair and hemangioma on the back. Assess for hydrocephalus and cord tethering. BRAIN: The ventricular system is not enlarged. There are foci of susceptibility effect in the posterior right inferior temporal sulcus, left collateral sulcus, and right cerebellar tonsil. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. In particular, there cerebellar tonsils are not low-lying. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. SPINE: There are postoperative findings related to lipomyelomeningocele surgery with overlying incision plane that may contain a small amount of residual fluid. There is a lipomatous mass in the posterior spinal canal at the L1 through L4 levels, measuring 1.6 AP x 1.5 RL x 3.9 CC cm. The lipomatous mass abuts and mildly deforms the caudal spinal cord. The tip of the conus medullaris is situated at the L4 level. The lower spinal cord does not appear to shift in position from prone to supine. There is a linear high T2 and low T1 signal band in the midline posterior subcutaneous tissues at the L5 level, which extends from the spinal canal to the skin surface, where there appears to be a flat cutaneous lesion. There is no evidence of syrinx. The vertebral column alignment is anatomic. The vertebral body heights are intact, but there is apparent deficiency of the posterior elements at multiple levels of the lumbar spine, which may represent dysraphism or surgical alterations.
1.No hydrocephalus, acute intracranial hemorrhage, or acute infarct. Tiny foci of susceptibility effect involving the temporal lobes and the right cerebellar tonsil may represent cortical mineralization from previous ischemia, infection, or hemorrhage. 2.Postoperative findings related to repair of the lipomyelomeningocele. The residual lipomatous mass, or caudal lipoma, is attached to the deformed caudal spinal cord and the tip of the conus medullaris lies at the L4 level.3.Suggestion of a possible sinus tract in the posterior subcutaneous tissues at the L5 level, perhaps with associated with a overlying cutaneous hemangioma. Otherwise, no evidence of a residual meningocele.