Dear Dr. Joshua, I had surgery 12/04 to remove a benign choriod plexus papilloma in the fourth ventrical. I now suffer from double vision, lack of coordination (left side) and poor balance. All of which have improved slightly, can I expect further improvement after two years?

How often should I have follow-up MRI’s? In the past two years, scans have also shown mastoiditis and fluid in both maxillary sinuses and the mastoid air cells. I have seen two ENT’s who blame my pain and balance problems on the brain surgery, the neurosurgeon told me to find another ENT. What do you think?

My last scan six months ago showed postsurgical changes in the posterior fossa midline and within the left cerebellar hemishere with residual areas of encephalomalacia. There is also an enlarged thecal sac in the upper cervical region that extends posteriorly and left laterally. This has remained stable compared to last scan. What is a thecal sac?

Thank you for your help. I am really glad I found this site! It is nice to know that I am not alone and to read about others who have gone through similiar ordeals.

Doctor Joshua’s Answer:

Hi, thanks for your question. In order to be able to provide a meaningful answer to your questions, I have some further questions for you, some of which may be difficult for you to answer, but maybe you can find the answer in your patient records or ask your doctor: Was a gross total resection achieved? Did the postoperative MRI show that the tumor is completely out? Was the final pathological-anatomical diagnosis a benign choroid plexus papilloma with no atypical properties? Where is the surgical scar (on the skin)? Exactly on the midline of the back of your head? What sort of pain are you suffering from? Is there any evidence of hydrocephalus on the MRI?

Given the present information, I’ll just say that your current symptoms should be systematically approached. The double vision should be evaluated by a neuro-ophthalmologist, and your sinusitis symptoms by an ENT specialist. It may well be that the balance problems, poor coordination and double vision are complications of surgery, but the sinusitis is unlikely to be explained by that, unless for some reason the surgery was done via a lateral approach and the mastoid air cells were compromised, in which case it’s theoretically possible that you have a CSF leak to the paranasal sinuses. Your balance and coordination problems should also be evaluated by a neurologist - it’s important to distinguish between inner ear and brain as the cause of your symptoms.

Thecal sac means that there is an enlarged sack of cerebrospinal fluid collection in the upper cervical region, probably as a complication of surgery. The significance of this is difficult to estimate without seeing the pictures and examining you physically. If you wish, you can e-mail me some scans of the MRI and I’ll have a look.

Please feel free to ask further questions on this matter.