Left insular oligodendroglioma, WHO grade II. Status post resection on April 28, 2016. There are changes related to the recent trans sulcal microsurgical resection of the left insular/subinsular mass. Fluid/air in addition to overlying scalp soft tissue thickening and underlying dural thickening in relation to the left temporal craniotomy result in minimal, if any, mass effect on the underlying brain. There is also left frontal pneumocephalus.There is a small T1-hyperintense, T2-hypointense focus with blooming on SWI, which is compatible with focal blood products and measures up to 7 mm, involving the resection bed along the left insular cortex and adjacent frontal pars opercularis. This is associated with diffusion restriction along the resection margin. There is new extra-axial contrast enhancement in the overlying sylvian fissure, probably reactive meninges. Otherwise, the infiltrative subinsular T1-hypointense, T2-hyperintense, noncontrast enhancing lesion is unchanged in size or configuration. Also, the thin linear tract of the previous biopsy through the lesion remains unchanged.Given the superficial location of the lesion and adjacent immediate postoperative changes, it is difficult to assess perfusion characteristics but there is no gross hyperperfusion in the tumor/resection bed.The ventricles and other cerebrospinal fluid spaces are unchanged in size and configuration, including a cystic septum pellucidum and vergae. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild maxillary mucosal thickening.
1.Interval resection of at least the superficial portion of the infiltrative left subinsular oligodendroglioma with similar contour of the remainder of the mass.2.Minimal hemorrhage in the resection bed with associated reactive meningeal thickening and other expected postoperative findings are described above.