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Figure 1: Preoperative images (a-g): CT (a-c) showing severe BI, thin C2 pedicles and deformed C1 lateral mass. MRI (d-g) showing fou rth ventricular lesion extending from foramen magnum to posterior t hird ventricular region. Postoperative images (h-o): Diffusion weighted MRI (h-j) after first surgery showing near total excision of the der moid. Intraoperative image (k) after posterior fusion showing b one graft lateral to titanium plates with no construct in midline (arrow). CT (l and m) and MRI (n) after T OO and posterior fusion showing no residual anterior compression. X-ray (o) showing titanium plates and sublaminar c ables

Figure 1: Preoperative images (a-g): CT (a-c) showing severe BI, thin C2 pedicles and deformed C1 lateral mass. MRI (d-g) showing fou rth ventricular lesion extending from foramen magnum to posterior t hird ventricular region. Postoperative images (h-o): Diffusion weighted MRI (h-j) after first surgery showing near total excision of the der moid. Intraoperative image (k) after posterior fusion showing b one graft lateral to titanium plates with no construct in midline (arrow). CT (l and m) and MRI (n) after T OO and posterior fusion showing no residual anterior compression. X-ray (o) showing titanium plates and sublaminar c ables