Status post meningioma resection 9/4/2013 and SRS treatment January 2015. Posttreatment follow-up. Thin cuts cavernous sinus. Fatigue, seizures, headaches. Again seen are postoperative findings related to left frontotemporal craniotomy with mild interval evolution. There is mild volume loss and gliosis involving the left anterior temporal lobe. Compared to 11/3/2014, there is been slight interval decrease in size of dural-based heterogeneously enhancing left parasellar mass that measures approximately 25 x 25 x 18 mm in the AP, transverse, and craniocaudal dimensions, previously 25 x 28 x 21 mm. Again seen is mass effect upon the adjacent left temporal and frontal lobes and left optic apparatus. There is mass effect on the left optic tract and to a lesser degree chiasm, slightly improved in the interval. The adjacent internal carotid artery, middle cerebral artery, and anterior cerebral artery flow voids do not appear to be significantly narrowed. Tumor contacts the pituitary gland without obvious mass effect. There appears to be some extension into the upper aspect of the left cavernous sinus. There is a peritumoral cyst laterally and minimal edema in the surrounding brain parenchyma which is improved. There is no evidence of new intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no significant midline shift or herniation. There are nasopharyngeal, maxillary, and right sphenoid sinus retention cysts.
1. Compared to 11/3/2014, there is mild interval decrease in size of left parasellar meningioma measuring approximately 25 x 25 x 18 mm, previously 25 x 28 x 21 mm. 2. Again seen is mass effect on the left optic tract and to a lesser degree chiasm but slightly improved in the interval. 3. Mass effect on the left inferior frontal and medial temporal lobes again seen. Gliosis in the left anterior temporal lobe consistent with postsurgical change.