Per EPIC, 21year-old female with Chiari status post multiple surgeries (first in 11/'07, last in 06/'09), ED, fibromyalgia with recurrent Chiari symptoms including headache, clumsiness, and dysphagia status post re-do Chiari decompression on 6/9/2015. BRAIN: There are postoperative findings related to revision of Chiari decompression with release as well as prior suboccipital craniectomy and resection of the posterior arch of C1. There is mild focal expansion of the thecal sac at the level of surgery. The previously seen lobule of pseudomeningocele just below the level of the neo-foramen magnum is no longer visualized. There is persistent dorsal tenting of the cervicomedullary junction but increased CSF space at the dorsal aspect of the cervical cord at the C2 level. The rounded cerebellar tonsils again extend to the approximate level of the upper margin of C2.CSF flow is not visualized and may be due to technical limitations. The ventricles and sulci are unchanged in size and morphology. The basal cisterns remain patent. There is no midline shift or mass effect. There are new foci of susceptibility in the right greater than left ambient cisterns, likely related to pneumocephalus. Susceptibility with associated FLAIR hyperintensity is seen in a linear fashion in the right frontal lobe, which may relate to previous catheter tract. There is no diffusion abnormality. No extra-axial fluid collection is identified. There is a left maxillary sinus mucosal retention cyst.Normal flow-voids are demonstrated in the major intracranial vascular structures.CERVICAL SPINE: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is stable small spinal cord syrinx from T3 extending inferiorly.There is no significant disc bulge, spinal canal or foraminal stenosis within the cervical spine.
1. Postoperative findings related to revision of Chiari decompression and probable lysis of adhesions as well as repair of pseudomeningocele with slight increased CSF space posterior to the proximal cervical spinal cord. CSF flow study is technically limited. Repeat CSF flow may be obtained as clinically warranted.2. Stable appearance of partially visualized tiny thoracic spinal cord syrinx.