PMC4419037_01
PMC4419037_02
Cervical and thoracic spine MRI. A: Extensive holocord syringomyelia with Chiari 1 malformation at the craniocervical junction (ectopic cerebellar tonsils extending1.4 cm below the foramen magnum). B: after surgery, the syrinx appears smaller in comparison to pre-surgical evaluation. A syringe-subarachnoid shunt is visible. 25x22mm (300 x 300 DPI)
nihms-657966-f0001.jpg
PMC4419037_02_nihms-657966-f0001.jpg
F1
MRI revealed a large cervicothoracic syrinx extending from C1 into the low thoracic region with associated Chiari I malformation (figure1). Although a post-surgical cervical spine MRI (figure 1) showed radiographic improvement of the structural abnormalities, the patient did not regain strength and muscle bulk in her hands.
PMC4419037_03
[A] Brain MRI: T1 image demonstrating Chiari malformation with 13 mm tonsillary protrusion, but no hydrocephalus; [B] T2 lumbo-sacral spine MRI: conus medullaris ending at the level of L2 and filum terminale adhesive to the dorsal dura at L4-L5. 90x48mm (300 x 300 DPI)
nihms-657966-f0002.jpg
PMC4419037_03_nihms-657966-f0002.jpg
F2
L2 with a small syrinx; the filum terminale appeared adhesive to the dorsal dura at L4-L5 (figure 2). Laminectomy at L4-L5 for tethered cord release and craniectomy with C1, C2 and C3 laminectomy for Chiari decompression were performed.