Female, 55 years old, with left temporal GBM status post resection. A wide left-sided craniotomy is seen involving portions of the left frontal, parietal and temporal bones with scalp edema and scalp fluid. Pneumocephalus is present, as well as epidural and subdural collections most likely representing a mixture of proteinaceous and hemorrhagic fluid measuring up to 11 mm in thickness subjacent to the craniotomy. A small amount of this mixed subdural fluid tracks along the left frontal lobe and posteriorly along the interhemispheric falx.The previously seen small left temporal resection cavity has been significantly enlarged to encompass a majority of the large ring-enhancing mass which previously occupied the left anterior temporal lobe and the insula. Resection of the anterior temporal lobe is complete with the exception of a residual island of superior temporal gyrus which contains a focus of hemorrhage. The surgical cavity margins demonstrate a thin coating of T1 hyperintense material likely representing evolving blood product. Along the posterior superior edge of the cavity, there is an ill-defined area of enhancement extending to the left ventricular atrium (see image 16 series 1101) which correlates with an area of restricted diffusion. Nonspecific curvilinear enhancement is also seen within and along the margins of the residual island of superior temporal gyrus (see image 15 series 1101, and adjacent slices). Nonenhancing thickened parenchyma remains evident along the posterior aspect of the left mesial temporal lobe, extending into the splenium of the corpus callosum.Restricted diffusion is seen along the posterior inferior margin of the surgical cavity, and as above, more superiorly extending to the left ventricular atrium. Generalized left cerebral mass effect is seen with sulcal effacement, partial effacement of the left lateral ventricle, and a 7 mm midline shift to the right. The left ambient cistern is narrowed but not effaced. The left uncus is displaced medially. Mild rightward mass effect persists upon the midbrain.No new enhancing or masslike lesions are seen. The right lateral ventricle is not dilated. Mild ill-defined periventricular FLAIR hyperintensity is nonspecific.
Findings are seen compatible with extensive left anterior temporal and insular tumor resection. Resection of the structures is complete with the exception of a residual island of superior temporal gyrus which contains focal hemorrhage.The previously seen large ring-enhancing tumor involving the left anterior temporal lobe has been nearly completely resected. Curvilinear enhancement within the residual left superior temporal gyrus is nonspecific and could represent tumor or surgical change. Ill-defined enhancement along the posterior superior surgical cavity margin is seen, but this correlates with restricted diffusion and may therefore represent parenchymal injury rather than residual tumor. Nonenhancing thickened parenchyma, presumably reflective of infiltrative tumor, is seen along the posterior most aspect of the left medial temporal lobe, extending into the splenium of corpus callosum.Generalized left cerebral mass effect is seen with sulcal effacement, left ventricular effacement, midline shift to the right and mild rightward shift of the midbrain.