 Postoperative changes are seen again seen from previous high right frontal parietal convexity craniotomy with underlying areas of encephalomalacia. There is a similar abnormal irregular contour to the clival margins especially inferiorly consistent with erosive changes, progressed since the prior MRI. There is mild overlying soft tissue thickening of the nasopharyngeal region without enhancement. There is a similar pattern of heterogeneous enhancement along the left sphenoid sinus.The ventricles and sulci are prominent, consistent with mild-moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are multiple scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. Similar pattern of patchy FLAIR hyperintensities also seen within the pons bilaterally. There is no pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. T1 hyperintense mucus retention cysts are identified in the posterior left ethmoid region. There is mild mucosal thickening in the maxillary sinuses with evidence of prior endoscopic sinus surgery. There is residual opacification along the right ethmoid cavity, with history of prior ethmoidectomy.
1. No acute abnormality. Stable pattern of abnormal FLAIR hyperintense foci within the white matter and brainstem , which are nonspecific but may relate to chronic small vessel ischemic changes.2. Grossly stable regular appearance of the heterogeneous clivus with mild overlying soft tissue prominence along the nasopharynx and enhancement along the left sphenoid sinus region, which again may be related to Rosai Dorfman disease.