Preoperative evaluation. History of malignant fibrous histiocytoma. Metallic artifact limits evaluation of the right frontal and parietal lobe. The dominant left temporal lesion measures up to approximately 48 mm, previously 42 mm, and contains blood products that are mixed T1 isointense and hyperintense and T2 hyperintense and hypointense, compatible with a combination of acute and subacute hemorrhage. There is adjacent T2 hyperintensity, compatible with vasogenic edema, and mild effacement of the occipital horn of the left lateral ventricle, unchanged. There are several other hemorrhagic lesions in the right occipital lobe, right medial temporal lobe, left inferior frontal lobe, right thalamus, and left cerebellar hemisphere. Many of the lesions display T1 hyperintensity and some have increased in size since 10/6/16. There is a small amount of right occipital horn intraventricular hemorrhage. The right frontal approach ventriculostomy catheter tip terminates in the region of the left thalamus, unchanged. There has been slight interval increased effacement of the left lateral ventricle trigone. The ventricles have otherwise not significantly changed in size, with mild diffuse periventricular T2 hyperintensity. There is no midline shift or herniation. The cerebral flow voids are grossly intact. The orbits are grossly unremarkable. There are left maxillary sinus retention cysts. There are postsurgical findings related to left frontoparietal craniotomy.
1.Multiple intracranial metastases with interval increase in size of the dominant left temporal lobe metastasis with acute upon subacute hemorrhage and vasogenic edema, accounting for differences in technique. Furthermore, some of the other intracranial metastatic lesions have increased in size since 10/6/16, perhaps due to recent hemorrhage.2.Shunted ventricular system with a small amount of intraventricular hemorrhage and slight interval increased effacement of the left lateral ventricle trigone. Of note, the tip of the catheter projects into the left thalamus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.