Female, 37 years old, with headache, status post third ventriculocisternostomy, with pineal mass status post biopsy. Again seen are sequelae of right frontal burr hole access and endoscopic biopsy of a pineal region mass. A small amount of intracranial and intraventricular air is seen compatible with recent redo ventriculostomy. Without the benefit of IV contrast, the T2 hyperintense pineal mass shows no significant change in size or morphology relative to the prior MRI examination. As before, the lesion splays the thalami but otherwise exerts no significant generalized mass effect.High-resolution midline sagittal imaging does appear to show a small defect in the floor of the third ventricle just anterior to the mamillary bodies. Cine flow imaging demonstrates robust flow related signal along the ventral brainstem and basal cisterns which appears to cease abruptly at the floor of the third ventricle. Mild flow related signal is detected within the third ventricle, though it is difficult to ascertain if this arises from CSF pulsation through the foramina of Monro or through the third ventriculocisternostomy.The caliber of the ventricles has improved relative to recent prior CTs, and now appears equivalent to that seen on the postoperative MRI from 9/5/2015. Mild T2 hyperintense rimming of the ventricular system persists. No new areas of parenchymal signal abnormality are detected. No restricted diffusion is seen. Mucosal thickening is evident in the maxillary sinuses.
1.Expected immediate postoperative findings compatible with recent redo ventriculocisternostomy.2.A small defect appears to be present within the floor of the third ventricle just anterior to the mammillary bodies. On cine flow imaging, however, no large jet of CSF flow is seen to freely communicate between the basal cistern and third ventricle. Mild flow related signal in the third ventricle could reflect a small communication, or it could simply represent CSF pulsatility through the foramina of Monro.3.Nevertheless, the caliber of the ventricles has improved relative to recent prior CTs and appears similar to that seen on the immediate postoperative MRI.4.No significant interval change is identified in the size or morphology of the pineal lesion.