History of endoscopic third ventriculostomy in 12/2013 for aqueductal stenosis. Please do flow study. There is interval resolution of the previously seen extra-axial collection along the right anterolateral frontal lobe. There is linear T2/FLAIR hyperintensity coursing through the right frontal lobe towards the ventricular margin relating to the previous surgical tract and likely representing to gliosis. A punctate focus of susceptibility is present along the right ventricular margin.In the area of known parenchymal hemorrhage in the right basal ganglia and thalamus, there is susceptibility artifact and a T2 hypointense hemosiderin ring. This has decreased in size, now measuring 10 x 9 mm, previously 16 x 15 mm. The lateral and third ventricular size is overall minimally decreased.CSF flow evaluation demonstrates some CSF flow along the floor of the third ventricle at the site of the third ventriculostomy extending into the posterior suprasellar cistern. CSF flow is not identified through the cerebral aqueduct where focal stenosis is identified on FIESTA images.There is no diffusion abnormality to suggest recent ischemia. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is new mild to moderate mucosal thickening of the bilateral maxillary, ethmoid and left frontal sinuses.
1. Compared to 1/3/2014, slight interval decrease in size of the lateral and third ventricles with cerebral aqueduct stenosis again seen. Postoperative changes relating to third ventriculostomy with presence of CSF flow through the surgical defect.2. Interval decrease in size of right basal ganglia/thalamic encephalomalacic cavity. 3. New moderate paranasal sinus disease.