Mark Hornyak, MD

This is a 20 year old male who presented with headache with pressure in back of the head when lifting weights, coughing, and laughing for more than 1 year, and getting worse. His neurologic exam is unremarkable.

• All
• Pre-Op
• Intra-op
• Post-op

MRI of the cervical spine. Midline sagittal image (left) shows several small fluid collections within the spinal cord. Axial image through C6 level (right) shows the largest fluid collection in the center of the spinal cord (called syringomyelia or a syrinx).

MRI of brain. Axial image through the base of the brain at the foramen magnum (left) shows crowding and pressure on the brainstem (red arrow). Midline sagittal image (right) shows herniation and descent of the cerebellar tonsils out of the base of the skull (represented by red arrow)

Intraoperative photo taken through the operative microscope. It shows the exposed dura of the posterior fossa and the upper cervical spine after removal of the suboccipital bone of the base of the skull and the lamina of C1. Orientation - this photo shows the back of the head and neck with the head being to the left of the image; right is to the top/left to the bottom.

Intraoperative photo taken through the operative microscope. The dura has been opened, and the next membrane that covers the brain is exposed – the arachnoid mater. The cerebellum can be seen through the hazy membrane. Orientation - this photo shows the back of the head and neck with the head being to the left of the image; right is to the top/left to the bottom.

Intraoperative photo taken through the operative microscope. A patch has been sutured into the opening, covering the brain and preventing the escape of cerebrospinal fluid. Orientation - this photo shows the back of the head and neck with the head being to the left of the image; right is to the top/left to the bottom.

CT of the head taken immediately postop. It demonstrates bone removed during the procedure. C1 laminectomy (left at arrow) and suboccipital craniectomy (right at arrow)

Postop MRI of the cervical spine. Compare with Figure 1. Sagittal image (left) and axial image (right) show resolution of syringomyelia.

Postop MRI of the brain. Compare with Figure 2. Sagittal image (left) and axial image (right) show increase in cerebrospinal fluid cushion around cerebellum (arrow).