 There has been suboccipital craniectomy with resection of the posterior C1 arch. Fluid intensity material is noted within the operative site, and changes within the overlying subcutaneous tissues are consistent with the patient's postprocedural status. The cerebellar tonsils are elongated, extending pathologically below the level of the foramen magnum, demonstrating a pointed morphology. There is abnormal T2 hyperintensity within the cervical cord beginning at the cervicomedullary junction and extending inferiorly to the T1 level. Cephalad to the C5 level, this is subtle and patchy, whereas from C5/6 through T1, it is more discrete and results in cord expansion. The odontoid tip is retroflexed causing mild abutment of the anterior cervicomedullary junction. Sagittal CSF flow studies were acquired in 4 different acquisitions utilizing 3 different velocity encoding settings. None demonstrate significant biphasic CSF flow involvement at the level performed in magnum and herniated tonsils.There appears to be a partially imaged left pleural effusion.There is straightening the cervical spine which is most likely positional. There are no fractures or subluxations. The marrow signal is benign. There are no degenerative stenoses.
1.There has been suboccipital craniectomy with resection of the posterior C1 arch. The cerebellar tonsils are elongated, extending pathologically below the level of the foramen magnum, demonstrating a pointed morphology. 2.There is abnormal T2 hyperintensity within the cervical cord beginning at the cervicomedullary junction and extending inferiorly to the T1 level. Cephalad to the C5 level, this is subtle and patchy, whereas from C5/6 through T1, it is more discrete and results in cord expansion. Although this may represent a presyrinx state, the region of cord expansion can be followed for interval changes to assess for possible concurrent neoplasm.3.Sagittal CSF flow studies were acquired in 4 different acquisitions utilizing 3 different velocity encoding settings. None demonstrate significant biphasic CSF flow involvement at the level performed in magnum and herniated tonsils.4.There appears to be a partially imaged left pleural effusion.