PMC6417344_01
Clinical photograph of swelling
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F1
The palpable occipital mass appeared shortly after the trauma, progressively enlarged over time, and reached the considerable size of 12 cm x 7 cm x 4 cm [Figure 1].
Axial and sagittal computed tomography images show the thin and bulging occipital external table resulting from the large, intradiploic cerebrospinal fluid density cyst. There was a severe thinning of the inner and outer table of the occipital bone. Bony defect was noted in the inner table in midline through which this lesion was communicating with fourth ventricle
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F2
Computed tomography scan of the head [Figure 2] showed a 12 cm x 7 cm x 4 cm large-sized cerebrospinal fluid (CSF)-attenuated intradiploic lesion in the occipital bone.
(a) Axial T2-weighted magnetic resonance images show the intradiploic cyst. Note that the signal intensity of the cyst is similar to that of the cerebrospinal fluid. (b) Sagittal T1-weighted and axial T2-weighted magnetic resonance images of cervical spine show the presence of syringomyelia extending from craniovertebral junction to C3 vertebral body level
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F3
Magnetic resonance imaging (MRI) of the head confirmed that the intradiploic lesion was filled with CSF and it was communicating with fourth ventricle [Figure 3a]. Screening of the cervical spine showed syringomyelia extending from craniovertebral junction (CVJ) to C3 vertebral body level [Figure 3b].
(a) Intraoperative photograph showing extremely thinned out outer table of the occipital bone along with evidence of cerebrospinal fluid within the intradiploic space. (b) Intraoperative photograph showing extremely thinned out inner table of the occipital bone (thinned outer table excised). (c) Small linear defect of 1 cm x 5 mm was visualized in the inner table along with underlying dural defect through which cerebrospinal fluid was coming into the intradiploic space
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F4
At surgery, the outer and inner table of the occipital bone was extremely thinned out along with evidence of CSF within the intradiploic space [Figure 4a and b]. Small linear defect of 1 cm x 5 mm was visualized in the inner table along with underlying dural defect through which CSF was coming into the intradiploic space [Figure 4c].
(a) Watertight repair of the dural defect was done using pericranium and then reinforced with fibrin glue. (b) Reconstruction of defect in the outer table was done using Osteomesh
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F5
Watertight repair of the dural defect was done using pericranium and then reinforced with fibrin glue [Figure 5a]. Defect of the outer table was repaired using Osteomesh [Figure 5b].
(a and b) Magnetic resonance imaging cervical spine done at 6-month follow-up showed a significant reduction in the size of syrinx
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F6
MRI cervical spine done at 6-month follow-up showed a reduction in the size of syrinx [Figure 6a and b].