Male, 10 years old, history of ventriculomegaly, syrinx evaluate for changes. Brain: Redemonstrated is evidence of Chiari decompression including suboccipital craniectomy and resection of the posterior arch of C1. The cerebellum fills the surgically widened foramen magnum similar to prior resulting in persistent near complete effacement of the CSF spaces at this level. A mild retroflexion of the dens, prominence of the soft tissues and ligaments surrounding the dens contribute to this effacement. Mild dysplasia involving the skull base including the planum sphenoidale and clivus again noted.On cine-flow imaging, flow related signal is evident along the anterior aspect of the brainstem and through the cerebral aqueduct into the fourth ventricle. Diminished biphasic flow is demonstrated ventrally and dorsally at the foramen magnumThe lateral and third ventricles remain mildly enlarged but without significant interval change. Minimal T2/FLAIR hyperintensity along the ependymal surface compatible with mild transependymal flow. For reference, the trans-frontal diameter measured in the coronal plane is 55 mm, previously 55 mm.No new areas of parenchymal signal abnormality are seen including no evidence of restricted diffusion. No edema or mass effect is identified. There is no evidence of any significant intracranial hemorrhage.Cervical and thoracic spine:Redemonstrated is a large syrinx which begins in the cervical spinal cord at the C2-3 level where it shows evidence of septation, continuing inferiorly throughout the cord to the level of the conus at L1-2. At C6-C7 syrinx measures 10 x 14 mm in the AP and transverse dimension which is unchanged. At T7-T8, syrinx measures 10 x 10 mm in the AP and transverse dimension which is also unchanged. When compared to prior two studies, there is minimal increase in caliber at the C3-C4 level where it measures 3 x 7 mm previously 3 x 4 mm on 8/7/2014. Otherwise no change in the craniocaudal extent of the syrinx.No significant spinal canal or neuroforaminal stenosis is seen. There remains a small central disk protrusion at C6-7, unchanged.
1.Redemonstration of surgical findings status post Chiari decompression. As before, the cerebellum fills/prolapses into the surgically widened foramen magnum resulting in near complete effacement of the CSF spaces at this level. Cine-flow imaging is unchanged and demonstrates diminished biphasic ventral and dorsal CSF flow.2.Mild ventriculomegaly is unchanged. No other significant brain abnormalities are detected.3.Redemonstration of a large caliber syrinx involving nearly the entire spinal cord. There appears to be minimal increase in caliber of the syrinx in its most superior aspect at the C3-C4 level compared to 2/19/2015 and 8/7/2014. However there is overall no significant change in the maximal caliber and craniocaudal extent.