Clinical question: Reexploration posterior fossa, removal of hardware, placement of 4 ventricular shunt with connection to distal left ventriculoperitoneal shunt and craniotomy Signs and symptoms: Postop follow-up.. Nonenhanced cervical/thoracic MRI:Examination demonstrates extensive postoperative changes of suboccipital midline decompression and extensive metallic hardware placement for craniocervical fusion which results in extensive artifact. There is a catheter/stent device in the fourth ventricle with the superior tip at the superior aspect of the fourth ventricle on the left and the inferior extent appears to lie either within the left cerebellar tonsil or immediately medial to the tonsil. The position of catheter/stent demonstrate no significant change since prior exam however previously noted focus of FLAIR hyperintensity/edema surrounding the catheter is no longer identified likely due to complete resolution. Similar to prior exam the fourth ventricle remains within normal size.Examination demonstrates interval increased size of a previously known expansile syrinx of entire cervical cord with resultant further reduced CSF space throughout the cervical spine.The significantly expansile cervical syrinx extends inferiorly to T7-T8 disc level. There are no prior thoracic MRI exam for comparison. Very extensive postoperative changes and including bilateral transpedicular screw placement throughout the thoracic spine makes precise assessment difficult. Within this limitation there is no convincing evidence of syrinx inferior to T7-T8 disc level.Nonenhanced brain MRI:Examination demonstrates postoperative changes of suboccipital midline decompression with extensive metallic hardware artifact for craniocervical fusion.Diffusion weighted series are severely compromised due to metallic hardware artifact however within this limitation no evidence of restricted diffusion is detected.Linear foci of hemorrhagic FLAIR hyperintensity (L>R) consistent with tracts of previously removed ventricular catheters are again noted. The signal intensity of brain parenchyma is otherwise within normal on all MRI sequences. The ventricular system remains within normal size and with maintained midline. The gray-white matter differentiation is normal.
1.Nonenhanced MRI of cervical and thoracic spine demonstrate interval increased size of significantly expansile syrinx of entire cervical cord and extending inferiorly to thoracic cord to T7-T8 disc level. Postoperative changes decompression and placement of a catheter/stent within the fourth ventricle demonstrate no significant change and with normal size of fourth ventricle. Previously noted FLAIR hyperintensity surrounding the stent/catheter demonstrate interval resolution. There are no prior thoracic MRI for comparison.2.Nonenhanced brain MRI demonstrate chronic changes secondary to bilateral frontal approach ventricular catheters as detailed, extensive postoperative changes of suboccipital decompression and metallic hardware artifact from craniocervical fusion. Unremarkable exam otherwise and with stable normal sized ventricular system.