Clinical question: Using for hemorrhage and tumor resection. Signs and symptoms: Status post craniotomy for tumor resection. Pre and post enhanced brain MRI:Examination demonstrates postoperative changes of a right-sided suboccipital craniotomy for removal of tumor. Expected postprocedural hemorrhage within the surgical site and resection cavity is detected.There is interval partial resection of the inferior aspect of a large mass in the right posterior fossa and the fourth ventricle.The largest transverse diameter of the tumor in the inferior aspect of right cerebellum measures at approximately 25 mm compared to prior study measurement of 45. There is resultant widening of subarachnoid space at this level and better visualization of right vertebral artery that on prior exam appear to be surrounded by this large tumor.The remaining tumor in the inferior right cerebellum abuts and displaces the medulla to the left without significant change since prior exam. There is no detectable new signal abnormality of the medulla or the pons abutting the tumor.Extensive residual tumor superiorly on the right and within the fourth ventricle still remaining. The largest transaxial dimension of tumor in the right and including the intraventricular component measures at 41 x 44 mm compared to prior study measurement of 41 x 47.5 mm. Mass effect and leftward herniation of the fourth ventricle is again identified and without significant change.There is significant interval decreased size of shunted supratentorial ventricular system since prior study. A right frontal approach ventricular catheter with the tip in the right frontal horn of lateral ventricle remains identical to prior exam. Decreased ventricular size results in better visualization of cortical sulci and CSF spaces supratentorially.
1.Expected postoperative changes of right suboccipital craniotomy for partial resection of a large mass in the posterior fossa.2.Residual mass inferiorly in the right posterior fossa buts and displaces the medulla to the left without significant change.3.Large residual tumor more superiorly and including the tumor within the fourth ventricle demonstrate no significant change. Mass effect and leftward deviation of the fourth ventricle remains stable since prior exam.4.Significant interval decreased size of supratentorial ventricular system and stable right frontal approach ventricular catheter with the tip in the right frontal horn.