Female, 6 years old, with history of ependymoma. Brain:Postoperative findings are seen compatible with occipital craniotomy. A right frontal approach EVD is in place. The tip of the catheter sits at the lateral margin of the right frontal horn and appears to have retracted somewhat when compared to the prior CT.Diffuse gyriform cortical restricted diffusion is seen involving the cerebral hemispheres symmetrically. Restricted diffusion is also demonstrated in the basal ganglia bilaterally, in the cerebellum bilaterally, with patchy involvement of the brainstem.Numerous heterogeneously enhancing masses are demonstrated intracranially. These are found primarily within the ventricles or the CSF spaces of the sulci and basal cisterns. Lesions range in size from punctate nodules to a bulky aggregate within the left suprasellar cistern which measures up to 5 cm. In addition to the discrete nodules, there is extensive dural enhancement and diffuse leptomeningeal enhancement particularly along the brainstem. Many of the tumor is demonstrated susceptibility effect and/or T1 signal compatible with blood product. The lateral and third ventricles are dilated similar to that seen on the prior examination. Periventricular T2 hyperintensity may reflect transependymal CSF flow. The fourth ventricle is somewhat distorted due to the presence of tumor and or postoperative changes.Spine:Diffuse dissemination of enhancing tumor is seen within the spine with areas of discrete nodularity as well as leptomeningeal spread. A very longitudinally extensive tumor is seen within the posterior lateral left spinal canal occupying the entire cervical spine and part of the thoracic spine. This lesion displaces and compresses the adjacent spinal cord. There is evidence of extensive spinal cord T2 signal abnormality which may reflect both edema and/or tumor invasion.Spinal alignment is anatomic. Vertebral body heights are preserved. Diffusely fatty marrow replacement may reflect prior radiotherapy. Bilateral airspace opacities and atelectasis of the left lower lobe are seen.
1.Findings are seen compatible with diffuse CSF dissemination of tumor involving the intracranial space and the spine. Bulky tumor deposits are evident within the ventricular system and in the subarachnoid spaces. Extensive tumor spanning the cervical and upper thoracic spine causes severe displacement and compression of the spinal cord.2.Evidence of diffuse hypoxic ischemic injury of the brain is demonstrated.3.Supratentorial ventricular dilatation appears similar to that seen on the prior CT examination. The right frontal approach EVD tip is positioned just at the lateral margin of the frontal horn and appears to have retracted relative to the prior CT.