Several neurologic sequelae from MVA in 2002 presenting with right lower extremity weakness. The patient had been treated with halo, C1-2 wiring, ventriculoperitoneal shunt, syringoperitoneal shunt @ T12, suboccipital decompression with duraplasty, O-C2 fusion, T1-L1 fusion. Now POD #1 for re-exploration of posterior fossa, removal of hardware, placement of 4th ventricle shunt with connection to distal left ventriculoperitoneal shunt, distal revision of ventriculoperitoneal shunt, and craniotomy for Chiari malformation. Brain: There are postoperative findings related to occipital decompression and cranio-cervical fusion with surgical hardware that produces artifacts that obscures surrounding anatomy. There is fluid overlying the duraplasty at the craniectomy site that measures up to 20 mm in thickness. There inferior cerebellum appears low-lying, extending to the level of the inferior margin of the C1 arch and indents the posterior aspect of the medulla, where there is patchy high T2 signal. There is also marked crowding of the neo-foramen magnum with impeded CSF flow and a dysplastic inferior clivus. There is linear T2 hyperintensity in the inferomedial cerebellar hemispheres and right frontal lobe, which may represent postoperative encephalomalacia or gliosis along surgical tracks. There is a left transfrontal ventricular catheter that terminates in the region of the left foramen of Monro. There is also a fourth ventricular catheter. There is a small amount of pneumoventricle. The ventricular system does not appear to be dilated. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no midline shift. The major cerebral flow voids are intact. There is mild scattered paranasal sinus mucosal thickening. There are scattered areas of postoperative scalp swelling.Cervical Spine: There is partially imaged thoracic scoliosis and scoliosis rods and screws, which produces artifacts that obscures surrounding anatomy. There is focal fusion of the dens and the anterior arch of C1. There is syringohydromyelia that extends from the level of the dens to the imaged upper thoracic spine, which measures up to 10 mm. There is no significant spinal canal stenosis.
1. Postoperative findings related to posterior fossa decompression, ventricular shunting, and craniocervical fusion, with suggestion of cerebellar slumping, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Extensive syringohydromyelia that extends from the level of the dens to the imaged upper thoracic spine, which measures up to 10 mm. Further evaluation of the rest of the spine may be useful.3. Partially imaged thoracic scoliosis and scoliosis rods and screws.