Medulloblastoma. Off treatment now. Status post resection, twice. Status post chemotherapy and radiation treatment. BRAIN: There are postoperative findings related to suboccipital craniotomy for resection of a cerebellar medulloblastoma. There is unchanged mild confluent T2 hyperintensity in the medial cerebellar hemispheres along the margins of the resection site, but no evidence of tumor. There are also unchanged scattered punctate foci of susceptibility effect in the cerebellar hemispheres and along a right occipital surgical tract. There is no evidence of acute intracranial hemorrhage or infarct. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. There is a focal left occipital scalp thickening and contrast enhancement with overlying subcutis fat stranding and skin tethering. Though these are new since the previous examination, they likely reflect scarring. Otherwise, the skull and extracranial soft tissues are unchanged. There is increased mucosal thickening in the maxillary and ethmoid sinuses, worse on the right. This is associated with bubbly secretions in the sphenoid sinuses. In the proper clinical setting, this may reflect acute sinusitis. There is no gross orbital abnormality. Mastoid air cells are clear.COMPLETE SPINE: The spinal cord and cauda equina nerve roots display normal signal characteristics. There is no evidence of abnormal enhancement within the spinal canal. The vertebral bone marrow displays diffuse T1 and T2 hyperintensity, compatible with radiation effects. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The marrow signal is more fatty than expected for age which reflects previous radiation treatment. Lungs show dependent changes. There is symmetric fullness of the pelvicalyceal systems and ureters but there is over distention of the urinary bladder.
1.No convincing evidence of tumor recurrence in the posterior fossa. 2.No evidence of drop metastases in the spinal canal.3.Increased mucosal thickening in the maxillary and ethmoid sinuses along with bubbly secretions in the sphenoid sinuses may reflect acute sinusitis in the proper clinical setting.4.Left occipital scalp soft tissue thickening may represent scarring.