Posterior fossa ependymoma, status post treatment, now with worsening ataxia, difficulty breathing. There are postoperative findings related to suboccipital craniotomy. There is no significant change in size of the somewhat infiltrative tumor with irregular peripheral enhancement in the right inferior fourth ventricle, cerebellopontine angle, right premedullary cistern, which measures up to approximately 5 cm. There is a right trans-cerebellar catheter that terminates within the tumor, along the medial aspect of a cystic space extrinsic to the tumor in the right cerebellopontine angle that measures up to 20 mm. There is associated mass effect upon the adjacent right cerebellar hemisphere, brainstem, and upper spinal cord. There is associated high signal diffusely within the cerebellum, right much more than left, pons, right middle cerebellar peduncle, and within the central portion of the upper spinal cord. There is a left transfrontal ventricular catheter that terminates in near the left foramen of Monro. The third and lateral ventricles nearly effaced. There is no midline shift or herniation. Although there is mass effect and perhaps encasement of the vertebrobasilar system, the flow voids are otherwise intact. There is no evidence of acute infarction or intracranial hemorrhage. There is persistent bilateral tympanomastoid fluid. There is diffuse paranasal sinus mucosal thickening.
1. Residual tumor in the posterior fossa with edema in the surrounding parenchyma is not significantly changed since March 2016.2. A cystic space extrinsic to the tumor in the right cerebellopontine angle is also not significantly changed since March 2016.3. The third and lateral ventricles are nearly effaced, with a left transfrontal ventricular shunt catheter in position. 