Female, 28 years old, with brain cysts, status post cyst aspiration. Redemonstrated is evidence of extensive prior right-sided surgery including hemispherectomy and multiple prior craniotomies with fragmentation and a large deficiency in the residual right calvarium.Findings are also seen compatible with recent revision of the patient's cyst catheter which has been replaced with a Rickham catheter. Artifact from the reservoir obscures visualization along the right calvarial defect.The extracranial/extradural fluid collection along the right craniectomy shows no significant interval change. The cyst catheter has been redirected posteriorly to penetrate a growing cyst as demonstrated on the prior MRI. The targeted cyst has indeed diminished in size. An adjacent slightly more anteriorly positioned cyst has not significantly changed. A cyst occupying the medial left temporal lobe measures 2 to 3 mm larger than on the immediate prior examination but is similar in size to the examination of 05/12/16. Extensive chronic cerebral dysmorphism is unchanged. The left sided periventricular white matter shows T2 hyperintensity which is stable to slightly increased in extent.
1.Findings are seen compatible with recent catheter revision and placement of a Rickham catheter directed slightly more posteriorly to drain a growing cyst. This targeted cyst has decreased in size relative to the prior examinations.2.A cyst just anterior to the catheter is unchanged in size. A cyst within the medial left temporal lobe shows some fluctuation in size over the two prior examinations but is not larger than that seen on the examination of 05/12/16.