Vision loss, evaluate left clinoid meningioma Again seen are postsurgical changes of left frontotemporal craniotomy for resection of previously seen extra-axial enhancing lesion in the left paraclinoid region. There is T2/FLAIR hyperintensity involving the left frontal lobe adjacent to the craniotomy which may represent retraction edema. There is also T2/FLAIR hyperintensity involving the posterior aspect of the left gyrus rectus and medial orbital gyrus compatible with edema in the surgical bed. No restricted diffusion to suggest infarct. There is linear enhancement at these sites. No discrete enhancing mass is evident to suggest residual tumor. Expected postsurgical changes include small amount of pneumocephalus and small extra-axial collection along the bilateral frontal and left anterior temporal convexity. Small intraventricular blood products in the right occipital horn also noted. Remainder of the brain demonstrates multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. No hydrocephalus. No evidence of mass effect, midline shift, or herniation. Major flow-voids are preserved. Evidence of bilateral intraocular lens replacement.
Expected postoperative changes related to meningioma resection without evidence of residual tumor. There is focal edema involving the posterior aspect of the left gyrus rectus and medial orbital gyrus in the surgical bed. Focal edema is also noted along the surface of the left frontal lobe beneath the craniotomy which may be related to retraction. No large hemorrhage or new mass effect is appreciated. Please note if there are new visual symptoms and evaluation of the optic nerves is desired, suggest dedicated MRI orbit study.