Basilar invagination status post suboccipital craniectomy and C1 laminectomy for decompression of brainstem. There are recent postoperative findings related to suboccipital craniectomy and C1 laminectomy for decompression of brainstem, with a small amount of fluid and emphysema along the surgical approach. There is a dysmorphic clivus, a prominent dens, and basilar invagination with persistent indentation upon the medulla by the dens, although the degree of spinal canal stenosis at the level of the dens has diminished. There is also considerable interval decrease in the extent of T2 hyperintensity within the spinal cord at the level of the dens, perhaps now with mild volume loss of the spinal cord at this location. There is long-segment fine linear T2 hyperintensity that extends inferiorly from this lesion along the left aspect of the spinal cord. The vertebral bone marrow signal is unremarkable and the aliment of the cervical spine is anatomic, beyond the region of the craniocervical junction. There are right thyroid nodules, which measure at least up to 15 mm. There is mild mucosal thickening in the maxillary sinuses.
1. Recent postoperative findings related to suboccipital craniectomy and C1 laminectomy for decompression of brainstem in the setting of basilar invagination, with persistent indentation upon the medulla by the prominent dens, but decreased spinal canal stenosis and spinal cord edema at the level of the dens, with what may represent the development of myelomalacia and associated right Wallerian degeneration.2. Right thyroid nodules. A thyroid ultrasound may be useful for further evaluation.