Chiari decompression, shunt, pseudotumor cerebri, 6 month followup: still with weakness in legs and neck pain. Brain: There are postoperative findings related to posterior fossa decompression with tenting of the inferior cerebellum and cervicomedullary junction towards the overlying dura. There is an unchanged small area of encephalomalacia in the inferior right cerebellar hemisphere. Cerebrospinal fluid flow appears to be intact across the anterior portion of the neo-foramen magnum. Otherwise, assessment posteriorly is limited by artifact from the shunt device. There is no gross evidence of intracranial hemorrhage, mass, or acute infarct. There is mild high signal within the bilateral basal ganglia and dentate nuclei. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. The major cerebral flow voids are intact. There is unchanged high T2 and low T1 signal in the left petrous apex and clivus. There may be bubbly secretions in the left sphenoid sinus. The orbits are grossly unremarkable.Cervical spine: There appears to be mild high T2 signal in the upper cervical spinal cord, although assessment is limited by motion artifact. The subarachnoid shunt catheter is present in the right upper cervical thecal sac. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is a posterior disc-osteophyte complex at C5-6 that abuts the spinal cord. There is also a small disc-osteophyte complex at C6-7 that does not contact the spinal cord. There is no significant neural foraminal narrowing. The paravertebral soft tissues are unremarkable.
1. Postoperative findings related to posterior fossa decompression with tenting of the inferior cerebellum and cervicomedullary junction towards the overlying dura suggests adhesion formation. 2. Apparent mild signal abnormality in the upper cervical spinal cord, although assessment is limited by motion artifact. 3. Unchanged left petrous apex and clivus lesion.4. A posterior disc-osteophyte complex at C5-6 that abuts the spinal cord. 