History of brain tumors, exact pathology unknown, and a ventriculoperitoneal shunt now presenting with headaches. There are post surgical changes related to a prior right parieto-occipital craniotomy. Immediately subjacent to the craniotomy flap there is a cystic collection in the right occipital lobe measuring 16 x 16 x 20 mm presumably reflecting a surgical resection bed. There is no associated enhancement or solid componentIn addition there is a right frontal approach ventriculostomy catheter with tip approaching midline at the level of the third ventricle. There is a small volume of gliosis along the ventriculostomy catheter tract. The ventricles are decompressed and somewhat slitlike in appearance.No foci of abnormal enhancement or mass lesions are evident. There are scattered periventricular and subcortical white matter foci of increased T2 signal compatible with mild chronic small vessel ischemic disease.No evidence of acute ischemic infarct or acute hemorrhage.The expected intracranial vascular flow voids are present. There is opacification of the right ethmoid air cells as well as mucosal thickening in the bilateral maxillary sinuses. Trace fluid in the mastoid air cells bilaterally. The orbits are unremarkable.
1. Postsurgical findings from prior right parieto-occipital craniotomy. Immediately subjacent to the craniotomy flap is a cystic collection presumably reflecting the resection cavity. There is no definitive evidence of recurrent or residual tumor, but comparison with prior imaging would be helpful.2. Right frontal ventriculostomy catheter in appropriate position. The ventricles are decompressed and somewhat slitlike in appearance.3. Mild chronic small vessel ischemic changes in the periventricular and subcortical white matter.4. Scattered paranasal sinus opacification; correlate with symptoms of sinusitis.