Reason: Evaluate for new baseline of recurrent GBM prior to initiating Tx on ALLIANCE HSPPC96 vax trial. History: recurrent GBM. The patient has undergone left-sided occipital craniotomy for debulking of a mass involving the left occipital lobe and posterior temporal lobe. There remains enhancing component of the tumor adjacent to the occipital horn of the left lateral ventricle previously measuring 39 x 19 mm axial dimensions and it currently measuring 50 x 38 mm axial dimensions. There is increased cerebral blood volume present at this location. Microvascularity can be identified in this same location on the susceptibility weighted imaging. There are blood products present at the operative site. There is a vasogenic pattern of edema which was also present on the prior exam and has not changed in extent compared small amount of extra-axial fluid is present at the site of the craniotomy flap. Associated T2 and flair signal hyperintensities surrounding this mass has mildly increased in extent and involves more of the medial aspect of the left parietal lobe than on the prior exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The sella is made of a developmental venous anomaly along the right frontal lobe associated with a small hemorrhagic lesion which is unchanged since the previous exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior exam the patient's left occipital mass has increased in size suggesting progression. 2.There is redemonstration of a hemorrhagic lesion in the right frontal lobe along the inferior frontal gyrus most likely representing a cerebral cavernous malformation associated with a developmental venous anomaly..3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 