4-year-old female with history of Chiari malformation and syringomyelia status post suboccipital craniectomy, C1 laminectomy and duraplasty as well as partial resection and tonsillopexy of the right cerebellar tonsil and reconstruction of the fourth ventricle outflow track on 7/25/2016. Postoperative changes of suboccipital craniectomy and C1 laminectomy are seen. There is a small expected fluid collection within the extracranial operative soft tissues. The portions of the cerebellar tonsils which previously extended into the cervical canal have been excised. There is diffusion restriction and susceptibility at the tonsillopexy margins, wit diffusion restriction also extending superiorly into the left cerebellar parenchyma. There has been improvement in mass effect exerted by the left cerebellar tonsil upon the medulla and upper cervical spinal cord. The ventricles and basal cisterns are normal in size and configuration. There is no hydrocephalus. There is no supratentorial signal abnormality, midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. The orbits are unremarkable.CSF flow imaging demonstrates mildly attenutated flow through the anterior aspect of the foramen magnum, similar to prior, but improved flow through the posterior aspect of the foramen magnum. There is also intact flow through the cerebral aqueduct and fourth ventricle. MRI CERVICAL SPINE
1.Postoperative changes consistent with Chiari decompression and tonsillopexy.2.Interval improvement in CSF flow through the posterior foramen magnum.3.Spinal cord syrinx, unchanged.