 There has been interval placement of a catheter via left frontal approach with tip in the suprasellar cystic portion of the known cystic and rim-enhancing lesion involving the sella and suprasellar cistern. Susceptibility artifact related to the catheter obscures much of the left frontal lobe and portions of the right frontal lobe. The main cystic component has significantly decreased in size now measuring approximately 12 x 19 mm in the axial plane (series 10, image 15) by approximately 22 mm in the craniocaudal dimension (series 11, image 81), previously approximately 28 x 35 x 42 mm. The superior portions of the lesion encroaches upon the third ventricle, and there is a component of the lesion which extends to the region of and probably narrows the left foramen of Monroe. Compared to the 6/29/2016 examination, there is significantly decreased mass effect related to the lesion. The left lateral ventricle remains mildly dilated, but is decreased in size both compared to the 6/29/2016 MRI as well as the 7/5/2016 CT. Previously seen midline shift has nearly resolved. A small amount of intraparenchymal hemorrhage noted on the prior CT is no longer visualized, likely post-procedural. There is a small amount of new increased T2/FLAIR signal surrounding the new catheter, likely gliosis. The previously seen increased T2/FLAIR signal within the periventricular white matter, compatible with subependymal CSF flow, has nearly resolved. The optic chiasm is not well delineated and may be adherent to the mass.There is no territorially restricted diffusion within the brain parenchyma to suggest acute ischemic infarction. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures.
1.Interval catheter placement with decrease in size of craniopharyngioma as well as decreased associated mass effect.2.Mild persistent dilation of the left lateral ventricle, improving from prior, likely related to narrowing of the left foramen of Monroe.