Reason: pre op please call neurosurgery on call to place fiducles 6876 History: pre op for craniotomy today The patient is status post right frontal craniotomy for right frontal lobe surgery. At the tumor resection site there is nodular enhancement present along the medial aspect of the right frontal lobe and medial aspect of the adjacent right cingulate gyrus. This was present on the 3/16/15 exam but is new since exams. There is cystic encephalomalacia present along the anterior aspect of the right frontal lobe with some surrounding T2 signal hyperintensity at the surgical site which remains relatively stable compared to the prior prior exam from march but has progressed over the past year. 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.Limited exam for surgical guidance.2.Compared to the prior exam from March there is no significant interval change in the appearance of the right frontal lobe and cingulate gyrus nodular lesions. This is suspicious for local recurrence.3.Status post right frontal lobe surgery.