Ependymoma brain, resection, new headaches, normal LP opening pressure. Evaluate for recurrence.. Brain:Unchanged areas of T2 hyperintensity within the pons, cerebellar peduncles, and right greater than left cerebellar hemispheres compatible with treatment changes. Redemonstrated is the patient's left frontal approach ventriculoperitoneal shunt with the tip of the catheter with the tip at the foramen of Monro and unchanged in position. There is minimal increase in size of the lateral and third ventricles compared to 10/29/2014. For example the third ventricle currently measuring 6 to 7 mm, previously 5 mm. There is susceptibility artifact related to the catheter. No reduced diffusion in the visualized brain to suggest acute ischemia. Evidence of prior right transfrontal ventriculostomy catheter also seen. There are innumerable foci of susceptibility throughout the brain compatible with radiation-related cavernous malformations better seen on prior VENBOLD sequence. The relatively largest of these measures 5 mm on the susceptibility sequence at the right temporal operculum and likely similar to prior allowing for differences in technique. Moderate degree of parenchymal calcifications within the cerebellar hemispheres are better appreciated on CT. Supratentorial T2/FLAIR hyperintense foci may represent chronic small vessel ischemic changes and/or treatment changes.Previously seen diffuse dural enhancement is markedly improved. No new or suspicious enhancement is appreciated in the brain. No intracranial mass or evidence of mass effect. Spine:There is deformity of the left ventral thecal sac at the cervicothoracic junction from C6 to T2 with mass effect on the left ventral cord, which maybe related to CSF loculation. Findings are unchanged from examinations dating back to 6/16/2010. No cord signal abnormality.No cord signal abnormality. There is thickening and abnormal leptomeningeal enhancement along the nerve roots of the cauda equina in the upper lumbar spine, not significantly changed since 3/26/2013. There is prominent T1 hyperintensity involving the lower cauda equina nerve roots at the level of the lumbar spine with mild enhancement, and also similar to prior.Small disk bulges at mild degenerative changes including small disk bulges in the lower lumbar spine are again noted. No high-grade spinal canal or neural foramina stenosis is seen. Left renal cyst
1. Post-treatment changes in the brain without evidence of intracranial mass or abnormal enhancement to suggest tumor recurrence.2. Compared to 10/29/2014, there is minimal interval increase in size of the ventricular system and decrease in diffuse dural enhancement. These findings would be compatible with improvement in previously seen findings suggestive of (relative) overshunting on 10/29/2014.3. Multiple subcentimeter foci of susceptibility throughout the brain which given remote history of radiation, are favored to represent multiple radiation-related cavernous malformations. No significant interval change allowing for differences in technique.4. Thickening of the cauda equina nerve roots with areas of nodular enhancement, findings which are not significantly changed since prior. Although persistent leptomeningeal disease can not be excluded, given stability since 3/26/2013 finding may represent treatment-related change. 5. Deformity of the left ventral thecal sac from C6 to T2 with mass effect on the left ventral cord likely related to adhesion/CSF loculation. Findings are unchanged from examinations dating back to 6/16/2010. No cord signal abnormality.