Clinical question: Status post craniotomy for resection of right parietal lesion. Signs and symptoms: As above. Pre and post enhanced brain MRI:Examination demonstrates a large focus of remaining vasogenic edema in high convexity right posterior frontal and parietal lobe abutting the right parietal surgical cavity. A surgical cavity containing serosanguineous fluid along the interhemispheric aspect of right parietal lobe measures at 25 x 16 mm in transaxial dimensions. There is T1 hyperintense signal intensity of surgical cavity secondary to expected postoperative blood which precludes precise assessment for detection of enhancing tumor. However within this limitation in this initial postoperative exam there is no convincing evidence of residual tumor at the surgical site however follow-up is needed to entirely exclude this possibility. Constellation of above findings results in effacement of adjacent cortical sulci and mass effect on the occipital horn and trigone of right lateral ventricle with trace leftward deviation of midline. There is however interval improvement of mass effect since preoperative study.Images through posterior fossa demonstrate a partially hemorrhagic solid mass in the left inferior cerebellar measuring at 20 mm in transverse and 18 mm in AP axis which is not significantly different since prior exam from 8-27-15. The mass demonstrates mild surrounding edema and mass effect without significant change since prior exam.No evidence of ventriculomegaly. CSF cisterns remain widely patent. Calvarium, orbits and paranasal sinuses are unremarkable.
1.Expected postoperative changes of left posterior parietal tumor resection as detailed. Expected postoperative T1 hyperintense contents of surgical cavity precludes precise assessment for detection of enhancement however within this limitation there is no convincing evidence of enhancing residual tumor. Further follow-up is needed.2.Stable partially hemorrhagic and enhancing left inferior cerebellar tumor, surrounding vasogenic edema and regional mass effect.3.Stable nondilated ventricular system and trace deviation of midline to the left with interval improvement since prior exam.