Reason: eval for pseudomeningiocele. CINE flow studies History: incision leak The exam is stable compared to the 4/23/15 exam as well as the 10/28/14 exam.The patient is status a suboccipital craniectomy and C1 posterior arch resection for Chiari malformation. There is redemonstration of a small focus of enhancement just behind the spinal cord at that level over the craniectomy site which measures 8 x 84 mm sagittal dimensions. It is unchanged since the 10/28/14 exam.The fourth ventricle and is thin and long. The corpus callosum is abbreviated at the level of the splenium. The cerebellum wraps around the brainstem. There is some evidence for tectal beakingThere is a focus of encephalomalacia in the right parietal lobe .The patient is status post ventriculostomy tube placement for shunt. A ventriculostomy tube course through the right parietal lobe into the right lateral ventricle with the tip along the anterior horn of the right ventricle. Another ventriculostomy tube courses through the left parietal calvarium into the body of the left lateral ventricle through the trigone and into the cingulate sulcusThe aqueduct of Sylvius is not readily identified.No abnormal enhancing mass lesions are appreciated in the brain parenchyma. No edema is identified within the brain parenchyma. Susceptibility artifact is present adjacent to ventriculostomy tubes and along the right parietal lobe focus of encephalomalacia.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left vertebral artery appears to be hypoplasticThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.The examination is stable. There is redemonstration of stigmata of Chiari two malformation as well is status post suboccipital craniectomy and shunt placement. The aqueduct of Sylvius is not readily identified. There is encephalomalacia in the right parietal lobe.2.A small focus of enhancement behind the cervical medullary junction is nonspecific but could relate to scar formation.3.The CSF flow study was not performed due to technical reasons.