77-year-old man undergoing surveillance for a previously resected meningioma. There are postoperative changes of right frontotemporal craniotomy for meningioma resection. There is susceptibility artifact in the right basal ganglia, inferior right frontal lobe and along the craniotomy site detected above blood products. Peripheral enhancement persists surrounding the residual blood products in the right caudate head. T2 hyperintensity from gliosis extends along the right frontal lobe unchanged from prior exam.Residual enhancing tumor in the anterior medial right middle cranial fossa measures 3.6 x 3.2 x 2.6 cm (series 902, image 108 and at series 3, image 69), unchanged. It extends into the right cavernous sinus as well as medially crossing the midline as on the previous exam. The mass encases the right cavernous and supraclinoid internal carotid arteries and is located directly anterior to and abutting the M1 and M2 segments of the right middle cerebral artery, with patent flow voids. No new areas of intracranial enhancement are identified.Scattered foci of T2 hyperintensity in the subcortical and periventricular white matter are compatible with mild chronic small vessel ischemic disease. There is a punctate foci of susceptibility artifact in the subcortical white matter in the left frontal lobe, stable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Mild thickening in scattered paranasal sinuses is unchanged. There is a sebaceous cyst along the left frontal scalp.
Stable postoperative changes related to subtotal right middle cranial fossa meningioma resection. The residual tumor is unchanged in size. No new enhancing lesions are identified.