Male, 16 years old, status post C2 spinal cord tumor resection, assess resection. Laminectomy has been performed at C1 and C2. A collection is evident in the operative bed containing a mixture of fluid, blood product, and bubbles of air. Air is also evident scattered through the thecal sac.The previously demonstrated intramedullary cystic lesion at C2 has been significantly decompressed. A small area of residual T2 hyperintensity is seen at the site of the cyst measuring 8 mm in length and up to 4 mm in width. Ill-defined cord T2 hyperintensity at and above the level of the lesion is relatively unchanged, perhaps representing edema. A small focus of susceptibility is seen in the ventral cord at the cranial edge of the lesion which may represent blood product or some other post-operative change.On post-contrast images, two small foci of enhancement along the ventral cord at C2 are redemonstrated, appearing minimally more prominent. However, decompression of the cyst may contribute to this apparent change. A focus of enhancement seen previously along the dorsal cord at C2 is no longer appreciated. A focus of enhancement in the left cerebellar tonsil, and faint enhancement along the dorsal cord at T1, are also unchanged. No new enhancing lesions are seen.
Findings are seen compatible with C1-2 laminectomy and decompression of a cystic intramedullary lesion at C2. A small area of T2 hyperintensity at the site of the cyst may represent sequela of resection or minimal residual cyst. Two foci of enhancement associated with the prior cyst along the ventral cord at C2 may be minimally more prominent than on the prior study, although altered cord geometry secondary to decompression of the cyst may contribute to this appearance. An enhancing focus along the dorsal cord at C2 is no longer appreciated. Other small enhancing foci are unchanged as above.