Diagnosis: Neoplasm of uncertain behavior of brain, unspecified Unspecified convulsionsClinical question: residual pilocytic astrocytoma after a subtotal resection, No follow up since 2012, evaluate for changesSigns and Symptoms: tumor, follow up , yearly Since the prior exam and heterogeneously enhancing mass located at the right pontomedullary junction associated with a septated multicystic component has increased in size. The enhancing component currently measures 47 x 30 mm coronal dimensions and previously measured 33 x 25 mm in coronal dimensions. The enhancing component that has enlarged most as the more superior aspect of the patient's neoplasm which bulges into the fourth ventricle. The combined cystic and solid component currently measures 55 x 51 mm axial dimensions and previously measured 41 x 31 mm axial dimensions. The cystic component has enlarged since the prior exam is along the more lateral aspect of neoplasm. The mass bulges further into the fourth ventricle relative to the prior exam. There is redemonstration of ventriculomegaly with enlargement of the temporal horns of the lateral ventricles. Biventricular diameter on coronal imaging at the level of foramen of Monro is currently approximately 67 mm and previously was approximately 69 mm. Third ventricular diameter remains at 17 mm.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since prior exam, a posterior fossa neoplasm which is consistent with the patient's diagnosis of pilocytic astrocytoma and is centered at the right half of the pontomedullary junction has enlarged.2.Since the prior exam ventriculomegaly has mildly regressed.