Surveillance. Additional history per chart, history of large posterior fossa ependymoma WHO grade 2 s/p resection x2 with VP shunt placement and adjuvant proton radiotherapy who presents for post-operative management following stereotactic cyst puncture and insertion of Rickham catheter. Following radiation therapy, the patient formed a large cystic structure in the former resection cavity in the right cerebellopontine angle. Subsequently, the patient developed a 7th nerve palsy and compression of the brainstem with right side weakness. Again seen are postsurgical changes of right occipital craniotomy related to partial tumor resection. The right occipital approach catheter traversing the right CP angle cystic lesion is unchanged in position. There is no significant change in cystic components at the right cerebellopontine angle which measures approximately 22 mm x 11 mm in the axial plane. The enhancing posterior fossa mass also does not demonstrate significant change in size measuring approximately 45 x 50 mm, axial image 11 series 1101. Mass measures approximately 37 mm in the craniocaudal dimension which is also not significantly changed. There is feathery pattern of enhancement likely reflective of posttreatment change. Mass effect on the cerebellum and brainstem with leftward deviation is unchanged. Unchanged pineal cyst with peripheral enhancement.Left frontal approach ventriculostomy catheter terminates at the foramen of Monro, unchanged. Ventricles are unchanged in size without evidence of hydrocephalus. Additional prior bilateral catheter tracts are noted with chronic blood products.Flow voids are present within the major vessels indicating patency. There is been significant interval increase in diffuse paranasal sinus opacification. Mastoid air cells also demonstrate increased opacification bilaterally.
1. Compared to 2/5/2016 there is no significant change in size of the posterior fossa ependymoma including the cystic components and associated mass effect. 2. There is increased diffuse opacification of the paranasal sinuses and mastoid air cells.