Board Certified Neurosurgeon Brain & Spine Care 860-889-9035
Mark Hornyak, MDBoard Certified Neurosurgeon
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Brain Case

Chiari Malformation

20 year-old man presenting with headache Pressure in back of head When lifting weights, coughing, laughing Over 1 year, and getting worse Neurologic exam is unremarkable

Description

20 year-old man presenting with headache
Pressure in back of head
When lifting weights, coughing, laughing
Over 1 year, and getting worse
Neurologic exam is unremarkable

Gallery

Images

Figure 1MRI 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).
Figure 2MRI 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)
Figure 3intraoperative 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.
Figure 4intraoperative 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.
Figure 5intraoperative 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.
Figure 6CT of the head taken immediately postop. It demonstrates bone removed during the procedure. C1 laminectomy (left at arrow) and suboccipital craniectomy (right at arrow)
Figure 7Postop MRI of the cervical spine. Compare with Figure 1. Sagittal image (left) and axial image (right) show resolution of syringomyelia.
Figure 8Postop MRI of the brain. Compare with Figure 2. Sagittal image (left) and axial image (right) show increase in cerebrospinal fluid cushion around cerebellum (arrow).
Figure 9Direct comparison of pre-operative and post-operative MRI’s demonstrating resolution of the syrinx at C6.

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