67 years, Female, preoperative planning for craniotomy for cavernous malformation resection. Examination is obtained for operative planning and intraoperative navigation with limited sequences. Fiducial markers are in place. Again seen are numerous foci of predominantly T2 hypointensity and susceptibility effect throughout the supratentorial and infratentorial brain. The largest of these involves the fourth ventricle and posterior aspect of the midbrain/pons measuring 16 mm AP x 20 mm transverse x 22 mm craniocaudal (as measured on T2 sequences previously). A relatively more prominent lesion involving the lateral aspect of the right postcentral gyrus measuring approximately 11 mm in the longitudinal axial plane is also again seen. Few of these lesions demonstrate areas of T1 hyperintensity, better assessed on the precontrast T1 sequence on prior study, as well as lobulated T2 hyperintensity. None demonstrate perilesional edema nor associated development of venous anomaly. The ventricles and sulci are normal in size. No midline shift or herniation. There is no abnormal enhancement within the brain. Major vascular structures are patent. Diffuse left mastoid opacification and mild to moderate scattered opacification of the paranasal sinuses again evident. Note is made of a small, fat-containing focus within the right parietal/occipital bone, which may represent small hemangioma or focus of fat.
Examination for operative planning again demonstrating multiple supra and infratentorial cavernous malformations.