Clinical question: Follow-up resection of meningioma. Signs and symptoms: As above. Pre and post gadolinium enhanced brain MRI:Examination demonstrates chronic post operative changes of a bilateral posterior parietal (R<L) craniotomy. There is a focus of encephalomalacia in the right occipital and posterior parietal with minimal cortical mineralization at the surgical site is noted.There is abnormal signal intensity of superior sagittal sinus at this level suggestive of tumor/meningioma within the superior sagittal sinus. This finding demonstrate enhancement and measures maximum of 9 x 11 mm in transaxial dimensions (axial FLAIR and T2 image 22 and axial post enhanced series 1001 images 22 through 24. There are no prior exams for comparison. The superior sagittal sinus beyond this lesion demonstrate normal signal intensity.The overall anatomical morphology and signal intensity of brain parenchyma remains otherwise within normal limits on all MRI sequences and without detectable or abnormal enhancement.Calvarium demonstrates expected postoperative changes and unremarkable otherwise.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.
1.Examination is status post bilateral posterior parietal-occipital craniotomy ((R<L) with underlying focus of encephalomalacia in the right occipital and posterior parietal.2.Residual signal abnormality and enhancement in the superior sagittal sinus in the occipital and posterior parietal concerning for residual tumor (9 x 11 mm transaxial dimension). No evidence of residual tumor otherwise and no prior exams for comparison.3.Unremarkable pre and post enhanced brain MRI otherwise.