This 30-year-old female presents with history of multiple surgeries to remove tumor. Annual followup. Evaluate for possible craniopharyngioma.
(QUIZ ANSWER) MASS, IN THIS CASE, IS STABLE:
Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.
Comparison MRI from 11 months prior.
Occipital postsurgical and craniotomy change with shunt tract decompressing the ventricular system and residing just anterior to the foramen of Monro with its tip in the anterior body of the corpus callosum. A second catheter tract is noted with a more oblique course whose tip resides near the most ventral medial aspect of the thalamus.
The patient's supratentorial mass is again identified and deemed to be a craniopharyngioma with an AP measurement of 2.4cm, a transverse measurement of 1.6cm, and a craniocaudad measurement of 2.17cm. The mass sits above the optic chiasm and has an intimate position relative to the hypothalamus and the foramen of Monro. The anterior third ventricle is effaced. Scattered areas of enhancement within the mass are identified posterior to a cystic cavity within with the cystic cavity measuring 6mm. Slow flow of the internal cerebral veins. Mild pituitary hypertrophy. As an aside, a removed shunt from an anterior right approach has a left a thin encephalomalacic tract behind in the right centrum semiovale and right middle frontal gyrus. Compared with the examination from 11 months prior, lesion size and shape as well as internal architecture remain absolutely stable. The shunt tract position in the callosum is unchanged. Shunt tract in the ventral medial thalamus is unchanged. Ventricular size is unchanged. No progressive hydrocephalus is appreciated.
1. Stable ventricular size consistent with the patient's shunting.
2. Stable shunt catheter placement.
3. Removed right frontal shunt with parenchymal involuting shunt pathway.
4. Stable supratentorial craniopharyngioma.
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Content reviewed: November 3, 2021