Clinical question: Postop. Signs and symptoms: Seizures. Pre and post enhanced brain MRI:Examination demonstrates a surgical cavity in the right posterior parietal and extending inferiorly into the right posterior temporal lobe abutting the trigone of right lateral ventricle. Surgical cavity demonstrates expected serosanguineous fluid content. Its irregular shape makes precise measurements difficult however it measures maximum of 29 mm in transverse, 20 mm in AP and 44 mm in craniocaudad dimensions. There is surrounding vasogenic edema and with resultant mass effect and including trace deviation of midline to the left.T1 hyperintensity within the surgical cavity representing blood products precludes precise assessment for presence of enhancement or detection of tumor. Within this limitation however subtle patchy thin linear enhancement along the surgical cavity wall is detected which is within expected postoperative change. Further follow-up is needed to exclude residual tumor.Unremarkable exam otherwise and without detectable abnormal focus of enhancement or signal abnormality.There is a small epidural collection under the craniotomy flap measuring approximately 9 mm in thickness with subtle mass effect on the adjacent parenchyma. Subgaleal serosanguineous fluid and air overlapping the calvarium in the surgical region is also noted. Expected postoperative pneumocephalus in the right frontal subarachnoid space is noted.
1.Surgical cavity measuring 29 x 20 x 44 mm extending from right posterior parietal inferiorly abutting the right trigone of the lateral ventricle. No convincing evidence of residual tumor on this initial study. Follow-up is needed.2.Vasogenic edema surrounding the surgical cavity and postoperative changes results in regional mass effect as well as trace deviation of midline to the left.3.Expected postoperative changes of 9 mm thick epidural collection under the flap and subgaleal fluid/air as well as right frontal subarachnoid pneumocephalus as detailed.