Male, 64 years old, with pain, pre-DBS insertion. Imaging was acquired with the patient head in a nonstandard oblique position due to patient range of motion limitations. The source images were reformatted into standard axial, coronal and sagittal planes for easier interpretation, but please note that these corrected images will likely not be compatible with the surgical navigation system.A cystic lesion is evident occupying and expanding the third ventricular space, though it may not actually be intraventricular but rather suprasellar in origin. The lesion is closely associated with both the optic chiasm and the pituitary infundibulum. The lesion abuts and exerts some mass effect upon the thalami, particularly on the right where a small fingerlike projection of the cyst may extend into the thalamic parenchyma. The lesion extends superiorly, between the forniceal columns, where there appears to be a 10 mm solid nodule with possible mild associated enhancement. On review of prior CT examinations dating back to 2011, this lesion was probably present, though it was substantially smaller and barely detectable at that time.No other pathologic enhancement is observed intracranially. The ventricles are not dilated. No additional abnormal extra-axial collections are seen. Scattered T2 hyperintense foci are evident within the periventricular and subcortical white matter.
1.The original images were acquired in a nonstandard oblique plane due to patient limitations. Although reformatted images were generated in standard anatomical planes, these corrected sequences will likely not be compatible with the surgical navigation system. The patient will be brought back to rescan with proper positioning.2.Incidentally noted is a cystic lesion with a small associated solid nodule which occupies and expands the third ventricular space, but which may actually be suprasellar in origin. This lesion was likely present in 2011, but has increased in size in the interval. The lesion exerts mass effect upon the thalami, right side more than left, and may even slightly invade the right thalamus. The imaging features favor a neoplastic process including a craniopharyngioma spectrum lesion. Findings were discussed with Dr. Warnke at 3:00 PM on 12/16/16.