Clinical question: History of atypical meningioma status post partial resection. Signs and symptoms: Surveillance prior to additional resection. Pre and post enhanced brain MRI:Examination demonstrates interval improvement of postoperative changes of a large right sided craniotomy for removal of tumor.Examination redemonstrates a large irregular and loculated tumor in the entire length of right cerebellopontine angle and into the right petrous bone, right internal auditory canal, right jugular fossa, right carotid canal, right cavernous sinus, right Meckel's cave, right medial aspect of the middle cranial fossa and through the expanded right foramen ovale into the right infratemporal fossa, extensively in the skull base on the right, sella turcica, left cavernous sinus and the sphenoid sinus. Although there is no significant change in the extent of tumor there is evidence of interval increased size of this meningioma in particular in the right cerebellopontine region.There is resultant interval increased vasogenic edema in the right cerebellum, right middle cerebellar peduncle and pons. Increased tumor size as well as surrounding edema results in increased mass effect on the fourth ventricle which appears smaller than prior study. Similar to prior exam to mass is abutting and mildly displacing the basilar artery without evidence of encasement or change in caliber of basilar artery. This is similar to prior exam. Dedicated vascular imaging, however is needed for better assessment.The tumor in the right petrous bone and carotid canal results in encasement, irregularity and mild decreased caliber of right internal carotid artery through the skull base, right cavernous sinus and proximal supraclinoid segments. This appearance is relatively similar to prior exam.Significantly expanded right cavernous sinus secondary to tumor and the component of tumor extends through the foramen ovale into right infratemporal fossa demonstrate no significant change either. There is however mild interval increased size of tumor component in the sphenoid and right orbital apex since prior exam.Extensive interval right temporal lobe cystic encephalomalacia at the site of previously noted parenchymal edema is identified. There is resultant ex vacuo dilatation of right lateral ventricle since prior exam.Interval significant decreased extra axial collection at the surgical site on the right results in resolution of midline shift to the left since prior study.
1.There is interval increased size of a large loculated extra-axial meningioma in the right cerebellopontine angle and with resultant increased vasogenic edema and mass effect as detailed.2.Extensive residual tumor in the right skull base, right jugular fossa, right carotid canal, right cavernous sinuses, right Meckel's cave, right orbital apex, sphenoid sinus, right middle cranial fossa and right infratemporal fossa as detailed above. The measurement suggests subtle interval increased size of different components of tumor at other locations as detailed above.3.Significant interval improvement of postoperative changes of right-sided craniotomy and interval evolution of previously noted right temporal lobe edema into a large focus of encephalomalacia as detailed.4.Interval decreased overall mass effect in the supratentorial space and with resolution of leftward midline deviation since prior exam. Please see above comments.