77 years, Male, evaluate meningioma, history of resection, postop 3 months.. Again seen are postoperative changes of right frontotemporal craniotomy for meningioma resection. Compared to 11/18/2015, evolution of postsurgical changes are seen including evolution of blood products within the right basal ganglia, right inferior frontal lobe, and along the right frontotemporal craniotomy. There has been development of volume loss involving the right frontal periventricular white matter and right basal ganglia with ex vacuo dilatation of the right lateral ventricle. There is enhancement surrounding the residual hematoma at the level of the right caudate head which can be expected. FLAIR hyperintensity related to gliosis extends to the surface of the right frontal lobe. Again seen is residual extra-axial tumor along the anterior medial aspect of the right middle cranial fossa and extending into the right cavernous sinus. Medial extension along the planum sphenoidale and crossing the midline is also noted. Residual mass measures approximately 3.6 x 3.2 x 2.6 cm, series 11 image 62 and series 1101 image 119. Compared to prior there is no evidence of tumor progression. Scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter are compatible with mild chronic small vessel ischemic disease. No new mass or mass effect. No midline shift or herniation. No hydrocephalus. The mass is again noted to circumferentially involve the right cavernous and supraclinoid internal carotid artery segments and is also intimately associated with the M1 segment of the right middle cerebral artery.
Evolution of postsurgical changes related to subtotal resection of meningioma as described above. Residual tumor which involves the right middle cranial fossa, extends into the right cavernous sinus, and along the planum sphenoidale is not significantly changed.