Clinical question: Patient is status post craniotomy/laminectomy for Chiari decompression, CSF leak. Signs and symptoms: Leaking fluid from surgical site. Nonenhanced brain MRI:Examination demonstrates postoperative changes of suboccipital midline craniectomy for Chiari decompression. There is no significant expansion of subarachnoid space on this initial postoperative study. Flattening deformity of cerebellar tonsil remains similar to prior study. There is expected postoperative epidural collection at the surgical site measuring approximately 40 mm in cranial cephalad axis and 9 mm in AP axis measured on sagittal images.There is minimal FLAIR hyperintensity of the medial aspect of bilateral cerebellar tonsils (R>L) representing post operative change (axial flair series 601 image 11 and coronal T2 series 801 image 24). This finding demonstrate no restricted diffusion.Unremarkable cerebral cortex, cortical sulci, ventricular system, brain myelination and CSF cisterns otherwise.
1.Postoperative changes of suboccipital craniectomy for Chiari decompression.2.There is no significant expansion of subarachnoid space at the surgical site and flattening deformity of cerebellar tonsils are again identified.3.Epidural collection at the surgical site within expected postop change and measuring 9 mm in AP and 40 mm intracranial cephalad access measured on sagittal images.4.There are tiny foci of FLAIR hyperintensity(R>L) of medial aspect of bilateral cerebellar hemispheres representing postoperative changes and without restricted diffusion.5.No convincing evidence of CSF leak on this study.