History of craniopharyngioma and progressive cysts status post partial resection and cyst drainage done March 30, 2013 as well as receiving weekly interferon on EPIC note dated 1/30/2015. Surveillance examination. Allowing for differences in technique and slice thickness, there is overall slight interval decrease size of the mixed cystic and solid tumor centered in the suprasellar cistern, compared to recent prior study dated 4/3/2015. The left cerebellopontine angle cystic component appears less convex with AP dimension measuring 7 mm (series 1001, image 17), previously is 10 mm . The left prepontine cistern cystic component measures 11 mm in short axis (series 1001, image 15), previously 14 mm. The right ambient cistern cystic component measures 16 mm in short axis (series 1001, image 13), previously 15 mm.Compared to the remote prior study dated 1/30/2015, there is interval increase in size of the right ambient cistern cystic component measuring 16 mm in short axis, previously 11 mm. There is interval decrease in size of the left prepontine cistern cystic component measuring 11 mm in short axis, previously 13 mm.There continues to be involvement of the prepontine, cerebellopontine angle cistern, right ambient and right quadrigeminal cisterns, as well as the right middle cranial fossa, with associated mass effect upon the brainstem, right medial temporal lobe, and hypothalamus-optic apparatus complex. There is asymmetric volume loss of the left cerebellar hemisphere suggestive of mild encephalomalacia, without significant interval change compared to 4/21/2014, but not present on exams prior to this. The basilar artery is tortuous and appears to be encased by the mixed cystic and solid mass.There are postoperative findings related to right temporal craniotomy and stable position of right frontal approach drainage catheter with tip in the right prepontine cyst. The ventricular system also appears to be unchanged. There are foci of susceptibility artifact within the right temporal lobe and left cerebellar hemisphere, consistent with hemosiderin deposition.
1. Compared to recent study dated 4/3/2015, slight interval increase in size of right ambient cistern cystic component and interval decrease in size of several other cystic components as described. Compared to more remote study of 1/30/2015, slight interval increase in size of right ambient cystic component with decrease in size of left prepontine cistern cystic component. For future follow-up, full MRI may be obtained with additional 2 mm axial T2 signal sequence to provide for best direct comparison.2. Asymmetric volume loss of the left cerebellar hemisphere suggestive of mild encephalomalacia, unchanged from 4/21/2014. 3. Stable shunt in the right prepontine cistern cyst. 