10 years Female (DOB:6/5/2006)Reason: posterior fossa tumor for surgical planning History: headache, vomiting, gait instabilityPROVIDER/ATTENDING NAME: LAZARO N SANCHEZ-PINTO There is a cyst and mural nodule mass present in the posterior fossa which involves the upper half of the vermis and has multiple peripheral nodules. There is associated compression of the fourth ventricle and upper brainstem as well as lateral ventricular enlargement and third ventricular enlargement. Lateral ventricles measure 51 mm biventricular diameter and a third ventricle measures 15 mm width. The temporal horns of lateral ventricles are dilated. There is associated periventricular T2 and FLAIR signal hyperintensity. There is also associated tonsillar herniation. The cerebellar tonsils extend 24 mm below the level of the foramen magnum. There is also transtentorial herniation with superior extension of the mass through the tentorial notch. There is compression of the brainstem associated with this mass as well. Differential considerations include a primary neoplasm such as a pilocytic astrocytoma. Other lesions I can't be cyst and mural nodule at this age may include pleomorphic xanthoastrocytoma and even cysticercosis in the appropriate clinical settingNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
There is a large posterior fossa mass centered along the upper vermis which is associated with mass effect, compression of the brainstem, transtentorial upward herniation and foramen magnum tonsillar herniation as well as ventriculomegaly with findings suspicious for subependymoma migration of spinal fluid..