Multiply recurrent atypical meningioma, now on Avastin. There are postoperative findings related to parieto-occipital craniotomy. There are multiple foci of extra-axial tumor along the posterior falx cerebri and tentorial leaflets, with invasion of the superior sagittal sinus, which are perhaps slightly larger than in October 2015. For example, the dominant parafalcine mass measures 46 AP x 27 RL x 45 SI mm, previously 44 AP x 25 RL x 37 SI mm. The associated extensive vasogenic edema in the adjacent brain parenchyma bilaterally appears to be similar in extent as before. However, there is now cystic encephalomalacia in the medial right occipital lobe with thin enhancement along the parenchymal margins and there has been evolution of the enhancement more laterally along the parenchymal margins of the left occipital lobe resection site with areas of apparently restricted diffusion and susceptibility effect. There is no large acute territorial infarct. There is ex vacuo dilatation of the right lateral ventricle and overall prominence of the left lateral and third ventricles. There is mild left sphenoid sinus mucosal thickening. The orbits are unremarkable. There are changes in the posterior scalp related to interval hardware removal.
Post-treatment findings in the posterior cranium with overall slight increase in size of multiple foci of recurrent meningioma along the posterior falx cerebri and tentorial leaflets with associated extensive vasogenic edema in the adjacent bilateral cerebral hemispheres since October 2015. Evolution of enhancement along the medial margins of the bilateral occipital lobes associated with encephalomalacia and perhaps necrosis may be treatment-related.