PMC5357741_01
T1 axial (A) and coronal (B) MRI images show expected postoperative changes after peri-insular functional hemispherotomy with high T1 signals corresponding to the areas of right hemispheric disconnection.
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After the preoperative workup, the patient underwent right-sided peri-insular functional hemispherotomy (Fig. 1).
Axial T2 MRI images obtained just before the shunt placement (A), about 10 days after the shunt surgery (B), about 5 months after the surgery and immediately before the shunt valve re-adjustment (C), and about 3 months after the valve re-programming (D) show overall stable ventricular size and configuration, except an initial expected postoperative decrease in the size of the ventricles and pseudomeningocele. The white arrow in (A) points to a pseudomeningocele at the prior operative site, and the white arrow in (B) points to the approximate location the ventricular catheter tip (The catheter tip is not shown in this particular image slice).
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A few months later, he presented with an episode of unresponsiveness, followed by episodes of emesis, with an MRI finding of pseudomeningocele (Fig. 2A). T2 MRI that showed an expected decrease in the size of the ventricles and pseudomeningocele (Fig. 2B). The symptoms spontaneously resolved, and he was discharged from the ER. These episodes required multiple evaluations at the ER which continued to show the overall stable neuroimaging findings (Fig. 2C). The ventricular size was noted to be stable 3 months after the valve re-adjustment (Fig. 2D).