27 years Male (DOB:9/7/1988)Reason: Chiari malformation , redo decompression /syrinx growth on last MRI, please do with CSF flow through foramen magnum stent. Post surgical exam-3month flu History: 3month post surgicalPROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM MRI brain: The patient is status post suboccipital craniotomy. Since prior exam a fluid collection at the craniotomy site has become a little more organized. It measures approximately 36 x 37 mm in axial dimensions. It appears to be separated from the cisterna magna with dura. A small communication cannot be excluded. There is a fourth ventricular stent extending from the aqueduct through the fourth ventricle and through the foramen of Magendie. There is T2 and FLAIR signal hyperintensity present within the adjacent cerebellar hemispheres and along the inferior medial aspects and along the cerebellar vermis posteriorly and inferiorly. This associated with volume loss.There is a ventriculostomy tube for shunt which crosses to the right occipital lobe and enters the occipital horn of the right lateral ventricle and has its tip in the body of the right lateral ventricle. The lateral ventricles are similar in size the prior exam and nondilated the left lateral ventricle remains larger than the right lateral ventricle.There is evidence for syrinx in the upper cervical cord. There is no significant stenosis at the foramen magnumNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.CSF flow study demonstrates no significant obstruction at the level of the foramen magnum.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is kyphotic angulation at the cervicothoracic junction.There is a syrinx redemonstrated extending from the C3-3 disc space level down to the C7-T1 disc space level maximal dimensions are currently 9 x 5 mm and on the 3/3/2016 exam or 12 x 8 mm.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a broad-based left paramedian disc protrusion present at this level associated with ligamentum flavum hypertrophy is greatest a mild to moderate degree of spinal stenosis. At C7-T1 there is a central disc protrusion present which impresses on the ventral aspect of the sac and effaces spinal fluid ventral to the spinal cord but not posterior the spinal cord. This was also present on the March exam and has not changed significantly in size.The vertebral artery flow voids appear to be intact.
1.Status post the posterior fossa craniotomy, fourth ventricular stent and ventriculostomy tube placement. There is a fluid collection behind the surgical site which appears more organized on the current exam. Etiology is uncertain2.There is no change in the size of the lateral ventricles since the prior exam and no evidence for ventriculomegaly. The patient's syrinx has decreased in size compared to the March exam.3.There is encephalomalacia present along the inferior medial aspects of the cerebellar hemispheres and vermis.4.There are degenerative changes present in the lower cervical spine which are stable. They narrow the spinal canal causing mild to moderate spinal stenosis at C6-7 and mild spinal stenosis at C7-T1