61 years, Male, status post craniotomy for tumor resection.. There are interval postsurgical changes of left temporal craniotomy for resection of a large enhancing mass centered within the left temporal lobe. There has been resection of majority of the tumor with residual enhancing tumor superior medial to the resection cavity involving the left periatrial region, where it is inseparable from the ependymal surface of the left lateral ventricle, along the inferior aspect of the resection cavity where it involves the dura abutting the petrous temporal bone, as well as minimal nodular component along the superior aspects of the resection cavity. There is also small amount of residual tumor medial to the resection cavity involving the medial left temporal lobe. There is polypoid herniation of the left uncus through the tentorium which was also present previously and is also involved with tumor. Extensive surrounding vasogenic edema is similar to prior.There is restricted diffusion compatible with cytotoxic edema/infarct along the resection cavity margin as well as a relatively larger area involving the left posterior temporal lobe extending into the occipital lobe. Again seen is an extra-axial fluid collection along the left cerebral convexity with effacement of the adjacent cerebral sulci, measuring approximately 16 mm in thickness, overall not significantly changed in size. Additional expected postsurgical changes include small volume pneumocephalus and blood products filling the resection cavity as well as moderate degree of scalp edema. Effacement of the left lateral ventricle is also similar to prior. The degree of left-sided uncal herniation with mild mass effect on the cerebral peduncle is stable to minimally improved. Rightward midline shift measures 11 mm measured at the level of the foramen of Monro which is also similar to prior.There is mild mucosal thickening throughout the paranasal sinuses. There is deformity of the left medial orbital wall likely related to chronic blowout fracture which is again seen.
1. Interval postsurgical changes of subtotal resection of a large solid and partially necrotic mass centered within the left temporal lobe with areas of residual tumor as detailed above.2. Subdural collection along the left cerebral convexity is again seen measuring up to 16 mm in thickness.3. Persistent mass effect including rightward midline shift and left uncal herniation as above.4. Cytotoxic edema/infarct surrounding the resection cavity and extending into the posterior left temporal and occipital lobes.