Sphenoethmoidal encephalocele and cleft palate. Reassessment. Compared to the postoperative September 2015 CT scan, the large midline sphenoethmoidal encephalocele has recurred. The encephalocele has reexpanded and now has a component that bulges into the upper aspect of the posterior nasal cavity. This component measures 14 mm at the base and 13 mm in height and is slightly smaller than on the preoperative MRI from April 28, 2015 where it measured 16 mm x 13 mm and was abutting the tongue. There is unchanged relative thickening of the posterior wall of this component of the encephalocele which may represent the floor of the third ventricle. The optic chiasm is probably part of this thickening laterally. The sphenoid bone is deformed. Soft tissue thickening along the anterior aspect of the deformed sphenoid body probably represents deformed pituitary tissue, with a stretched infundibulum. The acute postoperative changes in the frontal region have evolved. There is cystic encephalomalacia in the right frontal lobe anteriorly. The brain shows complete agenesis of the corpus callosum and associated colpocephaly, which remain unchanged. There is no acute infarct. Small foci of susceptibility effect are present deep to the frontal craniotomy flap. Otherwise, there is no acute intracranial hemorrhage. The major intracranial vascular flow voids are preserved. There is unchanged large palatal cleft , which also involves the maxillary alveolar ridge. There is hypertelorism and suggestion of midface hypoplasia. There is poor tissue contrast enhancement but there is no definite abnormal intracranial contrast enhancement.While the mastoid effusions have resolved, new fluid intensity is now present in the maxillary sinuses, worse on the left.
1.There is recurrence of the sphenoethmoidal midline encephalocele with herniation into the posterior nasal cavity.2.Multiple other structural abnormalities are described above, including a large palatal cleft, hypertelorism and midface hypoplasia, as well as agenesis of the corpus callosum.