 Limited imaging was obtained for surgical localization purposes. Post operative changes are again seen from left frontal parietal temporal craniotomy with minimal underlying scattered dural thickening and enhancement remaining. There is a small CSF signal intensity resection cavity along the anterior/superior left temporal lobe. There is adjacent lesion in posterior to the resection cavity in the left temporal lobe, better previous outside MRI.There is redemonstration of a masslike area of enhancement in the remaining left superior temporal gyrus, as well as additional nodule of enhancement in the inferior anterior left temporal lobe. The larger mass measures 12 x 17 mm in greatest dimensions by 15 mm in greatest CC dimension, enlarged since the previous outside exam (7 x 13 x 11 mm) allowing for differences in technique. The other smaller mass along the anterior/inferior aspect of the resection cavity measures 10 x 11 mm in greatest axial dimensions by 10 mm CC progressed since the previous exam, where the nodule measured 5 mm. It now demonstrates central hypoenhancement. The masses may be contiguous via curvilinear enhancement seen along the inferior margin of the resection cavity on 302/37. Branches of the left middle cerebral artery course in close proximity to these masses.The cisterns remain patent. There is no midline shift or mass effect. There is extensive abnormal T2/FLAIR hyperintensity involving the bilateral cerebral white matter and in near confluent pattern, left greater than right side, with ex vacuo dilatation of the left lateral ventricle. No extra-axial fluid collection is identified. The right cerebellar hemisphere is absent, likely developmental.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.
1. Interval progression of left temporal lobe enhancing masses which may be minimally contiguous via curvilinear enhancement, when compared to outside MRI. Findings are consistent with tumor progression.2. Redemonstration of extensive abnormal white matter signal, left greater than right side, which overall likely represents post treatment changes, although the left temporal lobe findings may represent a combination vasogenic edema and/or nonenhancing tumor.3. Right cerebellar hypoplasia.