 There is significant dilatation of the bilateral lateral ventricles due to a large intra- and suprasellar mass invading and obstructing the third ventricle. Periventricular T2 hyperintensity is compatible with transependymal flow. There is a large multicystic and solid mass arising from the sella with osseous remodeling of the sphenoid body. The entire left sphenoid sinus and the majority of the right sphenoid sinus are obliterated by the mass. The mass measures 4.9 x 6.3 x 4.2 cm and the solid portions avidly enhance. The superior portion of the mass is predominantly multicystic with fluid-fluid levels, which may represent blood, and scattered intrinsic T1 signal hyperintensity. There is encasement of the left internal carotid artery and lateral displacement of the right internal carotid artery. The right internal carotid artery is asymmetrically smaller compared to the left. The additional vessels within the circle of Willis are displaced peripherally by the mass. Presumably the optic chiasm and optic tracts are stretched, but are not clearly delineated on this examination.The cavernous sinus is likely filled with tumor. The right Meckel's cave is visualized and the left Meckel's cave is not visualized. There is mild bilateral convexity dural thickening and enhancement, likely secondary to recently shunt placement. Note that diffusion-weighted images are nondiagnostic anteriorly, as there is also dental hardware resulting in artifact.There are two frontal approach shunt catheters in place. The shunt catheter on the right extends to midline immediately superior to the suprasellar mass. The left catheter tip is in the body of the left lateral ventricle. A punctate focus of susceptibility effect is noted in the dependent portion of the left occipital horn, likely blood product secondary to shunt placement. Small amount of air in the nondependent portion of the right lateral ventricle. No extra-axial fluid collection is identified.
1.Large intrasellar and suprasellar partially multicystic enhancing mass causing hydrocephalus from obstruction of the third ventricle most likely represents a craniopharyngioma, versus other etiologies such as an adenoma, or less likely a germ cell tumor or primary astrocytoma.2.Encasement of the left internal carotid artery by the mass and lateral displacement of the right internal carotid artery.