Clinical question: Evaluate for hemorrhage. Signs and symptoms: Status-post grids in for seizure focus resection. Non-infused CT of brain:There is evidence of a large right temporal and frontal -- parietal craniotomy. Expected extra axial (epidural) air and fluid collection under the craniotomy flap is noted. There is overall increase mass effect in the right hemisphere with effacement of sulci and approximately 1 to 2-mm midline shift. There is evidence of a placement of epidural electrodes extending from the level of the floor of the right middle cranial fossa superiorly to above the level of lateral ventricles. Electrodes cover part of the right temporal lobe and extends superiorly into the parietal lobe. There is medial extension of electrodes which is best appreciated on axial image 11. The cortical sulci are not well visualized due to technique however I believe this component of electrodes are within the right sylvian fissure. There is no evidence of any parenchymal edema or hemorrhage. There is no evidence of ventriculomegaly. There is a focal area of CSF density within the expected level of right sylvian fissure noted on axial image 13. This corresponds with focal area widening of the sylvian fissure that was present on prior MRI examination. This is believed to represent a focal area of encephalomalacia of the operculum of right temporal lobe deep within the sylvian fissure. This is best appreciated on coronal T2 weighted images 15 through 17. No evidence of hemorrhage, edema, hydrocephalus is noted.
1.Expected postoperative changes of right craniotomy for placement of epidural electrodes over the right temporal and frontal lobes.2.Focal area of encephalomalacia believed to be within the operculum of right temporal lobe deep within the right sylvian fissure.