 Previous immediate postoperative changes have resolved. Postoperative changes from prior third ventriculostomy are not well visualized on this exam. The previous left parietal approach ventriculostomy catheter has been removed. The right ventricular catheter has been replaced, now coursing along the lateral margin of the right lateral ventricle, with tip in the right anterolateral frontal lobe parenchyma. A small amount of fluid is identified along the scalp and upper neck along the subcutaneous portion of the catheter tract, with associated enhancement. Surrounding the tip, there is prominent susceptibility with evidence of a small air-fluid level on axial T2-weighted images which may relate to recent catheter manipulation. A small amount of enhancement is noted following contrast demonstration along the proximal intracranial portion of the catheter, which likely is postprocedural. No other pathological enhancement is appreciated.The sulci are increased in prominence since the prior MRI, consistent with slight interval increased parenchymal volume loss. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. There is trace layering susceptibility in the left occipital horn, likely relating to post procedural blood products. A few other new foci are seen along the left lateral ventricular margin. A small area of FLAIR hyperintense encephalomalacia is present underlying the prior left parietal burr hole. Degree of myelination is difficult to assess secondary to relative paucity of white matter.Other previously described developmental abnormalities are unchanged. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Fluid is noted within the mastoid air cells and middle ears bilaterally which is nonspecific.
1.Essentially stable ventricular size with continued diffuse dilatation although slight interval increased parenchymal volume loss compared to remote MRI brain.2.Interval removal of left sided ventriculostomy catheter with replacement of right, which is noted abutting the lateral wall of the right lateral ventricle with tip in the right frontal lobe parenchyma, surrounded by a small air-fluid level which may relate to recent catheter manipulation. Fluid is also identified within the subcutaneous tissues tracking along the catheter course. Please correlate with physical exam.3.No significant abnormal enhancement to suggest infection, although enhancement is noted along the portion of the catheter in the lung the proximal intracranial portion which may be postprocedural. Please correlate clinically.Dr. Yang discussed these findings over the telephone with Dr. Castanda (PICU) on 1/29/2016 6:30 AM.