History of meningioma status post resection and radiation therapy now with new headache. There is evidence of prior left-sided craniotomy for biopsy or partial resection of tumor. There is redemonstration of a homogeneously enhancing extra-axial mass in the left superior cerebellopontine angle cistern measuring 22 x 22 x 28 mm (AP x TR x CC), previously 22 x 21 x 29 mm. The lesion abuts the dorsal aspect of petrous bone with resultant hyperostosis, with mass effect on the left aspect of superior pons. There is mass effect with effacement of the left Meckel's cave at this level. The enhancing dural tail of tumor extends along the left cerebellopontine angle inferiorly to the level of foramen magnum. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with chronic small vessel ischemic changes. There is unchanged extensive T2/FLAIR hyperintensity of the left middle cerebellar peduncle, which could represent a combination of edema and encephalomalacia from tumor and surgery. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a partially empty sella. The skull and extracranial soft tissues are otherwise unremarkable. There is mild scattered mucosal thickening of the paranasal sinuses.
1. No significant interval change in size of a homogeneously enhancing extra-axial mass in the upper left cerebellopontine angle cistern, consistent with known petrous apex meningioma. There is unchanged mass effect on the left aspect of the pons. Unchanged diffuse T2/FLAIR hyperintensity of left middle cerebellar peduncle with volume loss.2. No acute infarct. Mild to moderate chronic small vessel ischemic changes. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.