Reason: Right occipital meningioma; F/U History: Visual disturbance The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post right occipital craniotomyThere is redemonstration of a 20 x 15 mm axial dimension and 34 x 12 mm coronal dimension extra-axial mass adjacent to the medial aspect of the right occipital lobe which is centered within the superior sagittal sinus. The adjacent flow void of the superior sagittal sinus appear significantly narrowed but not defintively obstructed. On susceptibility imaging there are punctate signals of hypointensity within this mass. There is homogeneous enhancement following gadolinium administration. There is a small focus of enhancement which appears to extend into the an adjacent sulcus at the right occipital lobe. Compared to the 9/29 /2009 exam this has not changed in sizeThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.Findings are compatible with residual right parafalcine meningioma without no significant change in size compared to previous exams. The adjacent superior sagittal sinus is significantly narrowed but does not appear to be obstructed at this time.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 