8 year-old female status post cervical fusion. Examination again shows postsurgical changes of an occipital-cervical fusion, with an occipital plate, screw fixation device, cerclage wire and bone fusion material. There is redemonstration two of the occipital screws protruding deep to the inner table of the occipital bone. The previously seen Halo device fixation pin traversing the full thickness of the right frontal bone and resulting in fragmentation of bone has been removed. Four new Halo device fixation pins have been placed through the frontal bone outer table, and one new Halo device fixation pin through the right parietal bone outer table. There has been also relocation of the left parietal bone Halo device fixation pins. The brain is heavily obscured by streak artifact. Within this limitation, there is no gross hemorrhage , parenchymal lesion, or extra-axial fluid collection. However, the right frontal bone fixation pin area soft tissue detail is obscured by the streak artifact. There is no evidence of generalized mass effect, midline shift or basal cistern effacement. The ventricles and sulci are unremarkable where visualized.The paranasal sinuses demonstrate mucosal thickening. The debris in the nasopharynx is expected in an intubated patient. Mastoid air cells are clear. Orbital contents are unremarkable.
1. Stable postsurgical changes of occipital-cervical fusion, with an occipital plate, screw fixation device, cerclage wire and bone fusion material. 2. Interval adjustment and new placement of Halo device fixation pins, including the one protruding deep to the right frontal bone inner table, as above. 3. Intracranial contents are heavily obscured by the streak artifact arising from the Halo device. 