Female, 21 years old, with history of benign brain tumor, hearing malformation, spina bifida, and tethered cord. Follow-up for worsening symptoms. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. Parenchymal enhancement is within normal limits.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage The ventricular system is normal in caliber and morphology. Findings related to Chiari decompression are seen including suboccipital craniectomy and resection of the posterior arch of C1. The CSF space remains well expanded at this level and the cerebellar tonsils are neither crowded nor peglike. CSF flow is seen through both the anterior and posterior aspects of the foramen magnum, similar to prior. There is minimal deformation of the dorsal surface of the medulla which may reflect prior tumor at this location. There has been no significant interval change.C-spine:Straightening of the cervical lordosis may be positional. No significant malalignment is seen. Vertebral body height and morphology are within normal limits. No marrow replacement or marrow edema is seen.The spinal cord demonstrates normal signal intensity and morphology throughout. No spinal canal stenosis or neuroforaminal narrowing is detected.L-spine:Surgical findings are redemonstrated including multilevel laminectomy beginning at L2 and extending down into the sacral region. The thecal sac is expanded from L3 down, similar to the prior exam. There remains a small amount of fatty material along the posterior aspect of the thecal sac at the S1 level which is stable.The distal spinal cord remains very closely apposed to the posterior aspect of the thecal sac from the L2 level down. At lower levels the cord spreads and adheres along the posterior thecal sac and becomes inseparable from numerous septations and presumed areas of scar tissue. The overall appearance of these findings has not significantly changed.Spinal alignment is anatomic. Vertebral body morphology is within normal limits. No marrow replacement or marrow edema is suspected.No new intraspinal lesions are seen. The spinal canal and the neural foramina remain widely patent.The appearance of a skin dimple within the left aspect of the posterior soft tissues at approximately L4-5, along with an associated somewhat curvilinear tract which extends more deeply to the paraspinal tissues, is unchanged.
1. Redemonstration of findings related to Chiari decompression. The appearance of the tissues at the foramen magnum is stable. CSF flow is present along both the ventral and dorsal aspects of the foramen magnum.2. Minimal residual deformation of the dorsal medulla, at the site of prior tumor, is unchanged. No evidence of new tumor growth is seen.3. Evaluation of the cervical spine is otherwise unremarkable.4. Redemonstration of findings related to tethered cord and surgical correction in the lumbar spine. There has been no significant interval change in the appearance of these findings. 