PMC6356117_01
(A): MRI T2WI Axial and sagittal planes, showing the prepontomedullary multicystic hyperintense lesion, indented over the brainstem causing mass effect and narrowing of the foramen magnum. (B): MRI T1WI Sagittal and coronal planes, showing the multicystic hypointense lesion at the prepontine cistern. With no gadolinium enhancement. (C): CT-Angiography to evaluate the posterior circulation post-operatively as there were areas of ischemia post op suspected from a vasospasm, due to a reaction from the cyst content.
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T1 weighted images and hyperintense on T2 weighted images this lesion was not taking contrast and presenting a clear source of pressure over the pons and medulla, indenting the surface of pons (Fig. 1). The most probable differential diagnosis made was dermoid or epidermoid cyst, neurenteric cyst or hydatid cyst of parapontomedullary area.
(A): Post-operative MRI T1WI with and without contrast, revealed some relieve of the pressure from the brainstem, after excision of the cysts from the left petroclival and prepontine areas. (B): Some residual in the midline at the prepontomeduulary cistern, which is difficult to be reached by the left retrosigmoid suboccipital approach.
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