 There is redemonstration of postoperative changes in the left parietal lobe with foci of susceptibility within the resection cavity representing chronic blood products. Enhancement mass involving the left parietal resection cavity is decreased measuring 2.4 x 2.1 cm (14/103, previously 3.0 x 2.2 cm). There is extensive edema involving the left parietal lobe as well as the left temporal lobes similar to prior. Associated mass effect including effacement of the left lateral ventricle is minimally improved in the interval.There is redemonstration of an enhancing dural based lesion along the left lateral temporal lobe which is mildly decreased in size measuring 2.1 x 3.1 x 1.7 cm (14/181), previously 2.3 x 3.1 x 2.3 cm. The lesion exhibits mass effect with effacement of the frontal horn of the left lateral ventricle and mild 3 mm left to right midline shift, unchanged. A 7 mm enhancing lesion abutting the cortical surface of the left occipital lobe is less enhancing and slightly decreased in size since the previous study. Another left occipital lobe cortical based lesion is slightly increased in size (14/149) and measures 1.6 x 1.0 cm (previously 1.2 x 0.9 cm).There are no new enhancing lesions. The calcified subependymal nodules at the foramina of Monro are unchanged. There is no evidence of acute intracranial hemorrhage or acute infarct. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable.
1. Again seen is evidence of metastatic disease in the brain. Compared to 7/29/2015 the enhancing mass involving the left parietal resection cavity demonstrates decrease in size. Dural-based left lateral temporal mass also demonstrates mild decrease in size. A 7 mm peripheral left occipital lesion inferior to the resection cavity also demonstrates slight decrease in size. There is however interval enlargement of a left occipital cortically based lesion from 12 x 9 mm to 16 x 10 mm. No new lesions.2. Vasogenic edema in the left parietal, occipital, and temporal lobes is similar to prior.3. Calcified subependymal nodules are unchanged and consistent with history of tuberous sclerosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.