Biopsy proven pineocytoma WHO I status post repeated endoscopic stereotactic 3rd ventriculostomy for obstructivehydrocephalus. There are postoperative findings related to right transfrontal endoscopic third ventriculostomy and biopsy of a pineal tumor. There has been interval clearance of hemorrhage from the central defect in the remaining portion of the pineal tumor, which is otherwise unchanged in size, measuring up to approximately 25 mm. However, there is increased dilatation of the third and lateral ventricles, as well as the confluent periventricular white matter T2 hyperintensity, which is compatible with transependymal cerebrospinal fluid flow. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.
Interval evolution of postoperative findings without significant interval change in the size of the residual pineocytoma, but increased triventricular hydrocephalus associated with transependymal cerebrospinal fluid flow, which may indicate third ventriculostomy failure.