15 years, Male, pineal germinoma, now with hallucinations and shaking episodes. Evaluate mass and rule out other intracranial abnormality. Motion degradation mildly limits evaluation. A right frontal approach Ommaya catheter tip terminates at the foramen of Monro, unchanged. There is interval decreased size of a mixed cystic and solid mass within the pineal gland extending into the bilateral thalami, left greater than right, with the largest component measuring 1.8 x 1.2 cm (series 901, image 14), previously 2.0 x 2.0 cm on MRI June 12, 2015. The enhancing solid component extending along the medial aspect of the left thalamus is much reduced.There is persistent mass effect on the cerebral aqueduct and posterior aspect of the third ventricle. The lateral ventricles are mildly enlarged, but decreased in size compared to prior MRI June 12, 2015. A small defect is suggested along the floor of the third ventricle with T1 hypointense flow void (series 1301, image 6), suggesting patency of known endoscopic third ventriculostomy. There is no evidence of acute infarction. There is no intracranial hemorrhage. The remaining brain parenchyma is unremarkable. Bone marrow signal is within normal limits. There is no meningeal enhancement.
1.Compared to prior MRI 2/12/2015, there is decreased size of a mixed cystic and solid lesion within the pineal gland extending into the thalami, consistent with known germinoma. 2.Ventricular size decreased since MRI brain June 12, 2015, unchanged since CT head July 16, 2015, with suggestion of patent third ventriculostomy.3.Unchanged right frontal approach Ommaya catheter terminating in the foramen of Monro.