PMC7448254_01
PMC7448254_02
PMC7448254_03
Axial T2 (a) and sagittal T1 (b) MRI scans show hypoplasia of the cerebellar vermis with cephalad rotation of the vermian remnant, cystic dilatation of the 4th ventricle extending posteriorly, anterior displacement of the cerebellar hemispheres, and enlargement of the posterior fossa. The torcula lies higher than the level of the lambdoid suture due to the abnormally high tentorium which is opposite of normal.
CRIOR2020-8874819.001.jpg
PMC7448254_03_CRIOR2020-8874819.001.jpg
fig1
The MRI of the head and spine demonstrated hypoplasia of the cerebellar vermis and cystic dilatation of the 4th ventricle (Figure 1) and no vertebral, intraspinal, or paraspinal abnormalities.
PMC7448254_04
Preoperative posteroanterior (a) and lateral (b) radiographs of the spine show a severe right thoracic scoliosis producing thoracic translocation and spinal decompensation to the right with marked waistline asymmetry. Note that the global sagittal balance of the spine is retained as thoracic kyphosis and lumbar lordosis are compensated. However, the cervical spine is in a mildly kyphotic position. A supine X-ray was obtained with longitudinal traction (c) as part of the preoperative assessment, and this demonstrates that the thoracic curve retains mild flexibility.
CRIOR2020-8874819.002.jpg
PMC7448254_04_CRIOR2020-8874819.002.jpg
fig2
Surgery was performed 4 months after initial presentation, when the thoracic scoliosis measured 60  (Figure 2).
PMC7448254_05
PMC7448254_06
Bilateral hallux valgus which required surgical treatment after scoliosis surgery.
CRIOR2020-8874819.003.jpg
PMC7448254_06_CRIOR2020-8874819.003.jpg
fig3
At 9 months postoperatively, she was referred for surgical treatment of bilateral hallux valgus (Figure 3).
Posteroanterior (a) and lateral (b) radiographs of the spine at skeletal maturity show excellent scoliosis correction and a balanced spine in the coronal and sagittal planes.
CRIOR2020-8874819.004.jpg
PMC7448254_06_CRIOR2020-8874819.004.jpg
fig4
Spinal radiographs showed excellent deformity correction, which was maintained at follow-up with the instrumentation in good position and no evidence of pseudarthrosis (Figure 4).