Clinical question: Evaluate for post op pain. Signs and symptoms: Status post transphenoidal microadenoma resection. CT of brain without contrast:Portable CT of brain without contrast at bedside was obtained.Examination demonstrates expected postoperative changes of transphenoidal hypophysectomy. There is fluid density within the sphenoid sinus and ethmoid sinuses as well as fatty signal intensity within the sella which is believed to represent packing material. There is no evidence of hemorrhage within the subtle or intracranial space.There is evidence of a right sided ventricular catheter entering from the right frontal bone, traversing the right frontal lobe, entering the right lateral ventricle and with the tip at the level of foramina of Monro. There is near complete collapse of lateral ventricles.Previously noted on MRI examination the slightly dilated tip of the right temporal horn is again identified. There is no evidence of parenchymal hemorrhage, edema, mass effect or midline shift.Calvarium is intact. Mastoid air cells and middle ear cavities are unremarkable.Fluid level within bilateral maxillary sinuses, opacification of bilateral ethmoids and sphenoid appear to be result of recent surgical intervention.
1.Expected postoperative changes of transphenoidal hypophysectomy.2.Extensive fluid density within paranasal sinuses are result of prior surgical approach.3.Fatty density within the sella consistent with packing.4.No evidence of intracranial abnormality and in particular no hemorrhage.5.Shunt the right lateral ventricle and complete collapse of supratentorial ventricles.