 Again seen are postsurgical changes of suboccipital craniectomy for resection of cerebellar metastases. There is a small resection cavity involving the cerebellar vermis in the midline and just to the left of the midline. Just superior lateral aspect of the resection cavity on the left there is an area of peripheral enhancement with T2 hypointensity measuring approximately 10 x 12 x 12 mm on the post gadolinium sequence which is minimally larger than prior. The T2 hypointensity measures 8 x 7 mm, previously 6 x 7 mm. There is surrounding T2/FLAIR hyperintensity which is also stable to minimally increased in the interval.Remainder of the brain demonstrates no new parenchymal or meningeal enhancement to suggest progression of metastatic disease.There is no diffusion abnormality. There are scattered T2/FLAIR hyperintense foci in the periventricular and subcortical white matter which are nonspecific but similar to prior and may represent mild chronic small vessel ischemic changes. Major flow-voids are preserved. 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. There is thinning of the left posterior sclera compatible with staphyloma. The right eye is irregular in shape also similar to prior. There is no enhancing lesion identified in either eye. These findings are stable compared to prior exams.
Again seen are postoperative changes related to resection of cerebellar metastasis. Compared to 11/17/2015 there is minimal increase in size of a peripherally enhancing nodule with T2 hypointensity superolateral to the resection cavity. Surrounding edema is stable to minimally increased in the interval. These findings may represent evolving posttreatment changes given history of recent radiation; however recommend continued close follow-up to exclude the possibility of enlarging local recurrent tumor. No new lesion is seen elsewhere in the brain to definitively suggest tumor progression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.