17-year-old female with VP shunt, hydrocephalus, myelomeningocele, syrinx, yearly follow up. Brain MRI:The examination again demonstrates stable appearing ectopia of the cerebellar tonsils with associated deformity of the inferior poles of the tonsils. Findings of Chiari II malformation as well as corpus callosal dysgenesis are again seen. There is no evidence of hydrocephalus and shunt catheter terminating in the right lateral ventricle shows no interval change. Expansion of the tip of the left temporal horn is unchanged. No new hemorrhage, infarct, intracranial mass or mass effect.MRI complete spine:Examination redemonstrates stable segmentation anomaly of C2 and C3 level with fusion. There is effacement of ventral and dorsal subarachnoid space at the level of foramen magnum secondary to herniation of cerebellar tonsils and slight posterior projection of the dens. At the mid C2 level, anterior CSF space is reconstituted however there remains loss of the posterior CSF space. An expansile syrinx of cervical cord extends from C4 level inferiorly to T4 level, with a less expanded syrinx portion extending from T4 inferiorly to the T8 level on the left aspect of the cord, not significant changed since prior. Diffuse volume loss involving the cord appears similar to prior.The cord terminates at the approximate L5/S1 level level with a small covered meningomyelocele extending posteriorly through midline dysraphism of L5 and S1 level. Again seen is extensive scoliosis of the upper thoracic spine and levoscoliosis with apex at the thoracolumbar junction as well as exaggerated lumbar lordosis.
1.Compared to 9/11/2014, there is no significant change in brain MRI findings including Chiari malformation with tonsillar ectopia and dysgenesis of the corpus callosum. Stable caliber of the shunted ventricular system which remains decompressed.2.No significant change in size and extent of expansile syrinx of the cervical cord which extends from C4 level inferiorly to the T4 level as well as a less expanded syrinx portion extending from T4 inferiorly to the T8 level.3.No significant change in volume loss involving the spinal cord which terminates at the L5-S1 level and findings of myelomeningocele.