 Again seen are postsurgical changes of right transfrontal biopsy of pineal mass. Expected postsurgical changes include small amount of pneumocephalus and blood products including within the pineal gland and ventricular system. The pineal tumor again noted to obstruct the cerebral aqueduct. Interval third ventriculostomy is noted with defect involving the floor of the third ventricle suboptimally visualized, which is likely related to artifact. CSF flow sequence demonstrates a small jet of biphasic flow extending from the third ventricle to the pontine cistern indicating patency.There is mild decrease in the size of the lateral ventricles. For example third ventricle measures 8 mm in the transverse dimension, previously approximately 10 mm. Mild FLAIR hyperintensity in the periventricular region again seen related to transependymal flow and not yet resolved.No large hemorrhage, new mass effect, or edema. No midline shift or herniation.
1. Expected postsurgical changes of right transfrontal pineal tumor biopsy. Small defect is seen along the floor of the third ventricle with small jet of biphasic CSF flow extending from the third ventricle to the prepontine cistern suggesting patency.2. Mild decrease in the size of the lateral and third ventricles.