PMC3228381_01
Pre-operative imaging. (a) Axial FLAIR MR imaging demonstrating extensive peri-ventricular signal abnormalities. (b) CT (left), T1-weighted axial MR (center), and axial FLAIR MR imaging (right) demonstrating bilateral thalamic calcification with peri-calcification FLAIR signal abnormality. (c) Sagittal, axial, and coronal post-gadolinium T1-weighted and axial FLAIR imaging demonstrating a cystic lesion at the level of the pons effacing the fourth ventricle with peri-cystic FLAIR signal abnormality
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F1
Magnetic resonance imaging (MRI) confirmed these findings and additionally revealed extensive peri-ventricular and peri-cyst fluid-attenuated inversion recovery (FLAIR) signal abnormalities [Figure 1].
Operative findings. (a) Fenestration through the posterior wall of the pontine cyst. The lower retractor was placed over the left cerebellum. The upper retractor was placed over the right cerebellum. Rostral cerebellum was toward the left of the image, and caudal cerebellum was toward the right of the image. Suction cannula in each of the panels is identified by a white arrow. (b) Encountering a transparent greenish fluid collection upon cyst fenestration (black arrow). (c) Visualizing the anterior wall of the pontine cyst. (d) Mural nodule of the cyst visualized and biopsied (blue arrow)
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F2
Intraoperatively, green cystic fluid was obtained upon cystic fenestration [Figure 2].
Postoperative imaging. Sagittal, axial, and coronal post-gadolinium T1-weighted MR imaging taken (a) prior to cyst fenestration and (b) post cyst fenestration
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F3
Postoperative MRI revealed cyst decompression and an interval decrease in ventricular size [Figure 3].
Schematic of ventriculo-cysto-peritoneal shunting. The cyst catheter is T'ed into a right occipital peritoneal shunt at a site distal to the valve
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F4
The patient underwent placement of a cysto-ventriculo-peritoneal shunt in which a cyst draining catheter is connected through a "T" connector to a right occipital ventriculo-peritoneal shunt at a point distal to the valve [Figure 4].