PMC4533469_01
Preoperative cervical spine magnetic resonance imaging (MRI), sagittal sections: A: T1 weighted image (WI) and B: T2 WI, showing tonsillar herniation up to the C1 posterior arch level, a syrinx in the upper cervical cord and edema in the cord extending down up to C6 level.
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F1
His first MRI (Fig. 1) had showed evidence of tonsillar herniation upto the posterior arch of C1, a syrinx in the upper cervical cord, and edema extending down upto C6 level.
A: Postoperative cervical spine MRI done one day after the FMD-T2WI, sagittal section, showing a persisting syrinx and significant reduction in the cord edema. B: MRI cervical spine-T2WI, sagittal section, done a week after the FMD, showing complete resolution of the cord edema and reduction in the size of the syrinx. There is cerebellar slump as evidenced by decreased cranio-caudal sagittal dimension of the cerebellum as compared to that in Figs. 1B and 2A and impaction of the caudal cerebellum at the cervicomedullary junction. The aqueduct is dilated. C: MRI brain-T2 WI, coronal section, demonstrating an infratentorial subdural hygroma on the left side. D: Plain CT brain, axial section, showing triventriculomegaly with periventricular lucency and the left sided infratentorial subdural hygroma. WI: weighted image, MRI: magnetic resonance imaging, FMD: foramen magnum decompression, CT: computed tomography.
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F2
MRI showed significant reduction in the cord edema and persistence of the syrinx (Fig. 2A). MRI at the time of the neurological deterioration a week after the FMD showed complete resolution of the cord edema and reduction in the size of the syrinx (Fig. 2B). These findings were not seen in the immediate postoperative MRI (Fig. 2A). There were additional findings of an infratentorial subdural hygroma (Fig. 2B-D), a dilated aqueduct (Fig. 2B), and triventriculomegaly with periventricular lucency.
Follow-up magnetic resonance imaging cervical spine, T2 WI, sagittal section, showing further resolution of the syrinx as compared to that in Figs. 1 and 2. There is resolution of the cerebellar slump and of the infratentorial subdural hygroma. WI: weighted image.
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F3
A follow-up MRI after 6 months showed further resolution of the syrinx, well decompressed ventricles, reversal of the CS, and resolution of the infratentorial SDH (Fig. 3).