Chiari, status post decompression, syrinx, worsening head and neck pain. Brain: There are postoperative findings related to Chiari decompression surgery and fourth ventricular stenting. There is kinking of the cervicomedullary junction posteriorly towards the overlying dura, which appears similar as on the prior exam. There is flow of cerebrospinal fluid across the neo-foramen magnum anteriorly, but not posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is a partially empty sella. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.Spine: There are 13 thoracic vertebrae. There is residual trace prominence of the thoracic spinal cord central canal. The conus medullaris is positioned at the lower L1 level. There are postoperative findings related to tethered cord release and partial resection of filar fibrolipoma, with residual punctate T1 hyperintensity at the L1-2 level and linear T1 hyperintensity extending from the L3-L4 level to the distal end of the thecal sac. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is mild degenerative spondylosis involving the lower lumbar spine, but no significant spinal canal stenosis.
1. Postoperative findings related to Chiari decompression with kinking of the cervicomedullary junction posteriorly towards the overlying dura, which may secondary to adhesion formation.2. Trace residual thoracic syrinx. 3. Postoperative findings related to tethered cord release and partial resection of filar fibrolipoma, with the conus medullaris positioned at the lower L1 level. 4. Nonspecific partially empty sella.