Right frontoparietal grade 2 meningioma status post STR and XRT. Again seen are postsurgical changes related to near total resection of a large right parietal parasagittal meningioma. Residual tumor involving the mid superior sagittal sinus is not significantly changed when compared to most recent local exam from 12/23/2015, measuring up to 9 mm in the transverse dimension and 12 mm in the craniocaudal dimension. Superior sagittal sinus posterior to this level remains patent. Again seen is encephalomalacia involving the right paracentral lobule.Extra-axial fluid collection along the high parietal convexity beneath the craniotomy measuring approximately 13 mm in thickness is not significantly changed. Chronic blood products along the superficial aspect of the right parietal lobe as well as a focus in the right parietal corona radiata again seen.There is no evidence of acute ischemia or new hemorrhage. Extent of FLAIR signal involving the bilateral frontoparietal centrum semiovale extending into the corona radiata is similar to recent outside MRI although increased when compared to 12/23/2015, findings likely reflecting post radiation change. There is focal enhancement involving the left parietal calvarium, series 11 image 9, measuring approximately 19 mm, previous 14 mm on 12/23/2015. Lesion is not apparent on earlier MRI from 7/11/2015. There is also focal enhancement involving the left frontal calvarium, series 11 image 6, which also appears more conspicuous than on 12/23/2015. There is no evidence of intracranial mass effect, midline shift, or herniation. Ventricular system is unchanged without evidence of hydrocephalus.
1. Postsurgical changes of near total right parietal meningioma resection. No significant change in residual meningioma involving the superior sagittal sinus compared to 12/23/2015.2. Increased T2/FLAIR hyperintensity involving the frontoparietal centrum semiovale and corona radiata likely representing post radiation change.3. Enhancing lesions involving the left parietal and left frontal calvarium which appears slightly larger than on 12/23/2015 and difficult to appreciate on earlier prior studies. Unclear if these reflect posttreatment change, benign lesions which appear more prominent due to slight differences in technique or more sinister etiology. Would suggest obtaining head CT for further evaluation to assess for destructive osseous changes in these regions.