 Brain: Again seen are postoperative findings related to Chiari decompression. Unchanged mild patchy T2 hyperintensity in the inferior right cerebellar hemisphere compatible with gliosis. Neo-foramen magnum is widely patent. CSF flow is preserved across the anterior and posterior aspects of the neo-foramen magnum, although the anterior flow column remains minimally constricted due to the retroflexed dens. The third and lateral ventricles are mildly prominent. Cerebral aqueduct is patent most evident on 3-D T2 as well as CSF flow sequences. There is no midline shift or mass effect. There is no evidence of acute infarct or hemorrhage. Spine: There is trace prominence of the central canal from C3 to C5 levels as before. Again seen is a syrinx extending from the lower C6 level into the thoracic cord. Syrinx measures approximately 2 x 3 mm at the T1 level which is not significantly changed since cervical spine MRI 9/17/2015. Compared to the examination from 4/23/2015 when the thoracic spine was completely evaluated, there is clear decrease in the caliber and extent of the syrinx. For example at the T4 level, syrinx currently measures 4 x 3 mm, previously 10 x 7 mm on examination from 4/23/2015. Decreased cranial extent of the syrinx in the cervical spine was also noted on more recent MRI dated 9/17/2015. Caudally in the thoracic spine, the syrinx tapers inferiorly to the T11-12 level which was the inferior extent on prior study from 4/23/2015, although the caliber of the syrinx was larger at that time throughout the thoracic cord. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foraminal stenosis at any level. Conus terminates normally at the L1-L2 level. No evidence of tethered cord.
1.Postoperative findings related to Chiari I decompression with preserved ventral and dorsal CSF flow at the foramen magnum.2. Compared to prior complete spine MRI from 4/23/2015 when the cord was completely imaged, there is significant decrease in size and extent of the cervicothoracic syrinx. The improvement was partially evident on more recent MRI cervical spine exam from 9/17/2015.3. Unchanged mildly dilated lateral and third ventricles with patent cerebral aqueduct.