Resection of ovarian metastases. There are postoperative findings related to recent right frontal craniotomy for resection of a right frontal lobe metastases. There is an intermediate T1 and low T2 signal epidural collection with susceptibility effect in the right frontal convexity anterior to the craniotomy margin that measures up to 20 mm in thickness. There is fluid and hemostatic agent within the right middle frontal gyrus resection cavity, which displays fine linear enhancement along the anterior margin. In addition, there is mild diffuse restricted diffusion surrounding the resection cavity that is out of proportion to the extent of susceptibility effects from blood products. There is also persistent extensive vasogenic edema surrounding the resection cavity. Likewise, there is considerable vasogenic edema associated with the left frontal lobe and right peritrigonal metastases. Overall, there is resultant 8 mm of midline shift to the left, subfalcine and uncal herniation, and partial effacement of the right lateral and third ventricles, which is unchanged. A subcentimeter metastasis in the right cerebellar hemisphere is associated with mild surrounding vasogenic edema. The major cerebral flow voids are intact.
1. Recent postoperative findings with a right frontal convexity epidural hematoma that measures up to 20 mm in thickness.2. Fine linear enhancement along the anterior margin of the right frontal lobe resection cavity may represent residual neoplasm or post-treatment effects, although the extensive vasogenic edema and remaining intracranial metastases persist and contribute to 8 mm of midline shift to the left, subfalcine and uncal herniation, and partial effacement of the right lateral and third ventricles, which is unchanged. 3. Mild acute ischemic changes surround the right frontal lobe resection cavity, but no evidence of acute territorial cerebral infarction.