Male, 40 years old, with history of pineal tumor status post resection with hydrocephalus, VP shunt revised on 5/2015. Assess ventricular megaly. A right parietal approach ventricular shunt catheter is in place coursing through the right lateral ventricle and terminating to the left of midline within the left lateral ventricle. Since the prior examination, the size of the lateral ventricles has significantly increased. They were previously slitlike and now are significantly dilated with a transfrontal diameter of 5 cm. A rim of T2 hyperintensity around the ventricles is new and compatible with transependymal CSF flow.Postoperative changes in the posterior fossa and pineal region are redemonstrated including T2 hyperintensity and encephalomalacia of the vermis and paramedian cerebellar hemispheres. A previously demonstrated small enhancing focus in the pineal region is not distinctly appreciated on this examination which may reflect differences in technique. Otherwise, no significant interval change is seen in these postoperative findings.An area of thickening and enhancement along the undersurface of the left tentorium is unchanged. No definite new pathologic intracranial enhancement is seen. No evidence of acute intracranial hemorrhage is detected. Sequelae of prior right frontal approach instrumentation are redemonstrated.
1.Interval development of supratentorial ventriculomegaly with evidence of transependymal CSF flow.2.Stable postoperative findings in the posterior fossa and pineal region. A focus of enhancement seen in the pineal region on prior examinations is not distinctly visualized which may be technical.3.Nonspecific thickening and enhancement along the undersurface of the left tentorium is unchanged and favored to be postsurgical in nature.