Male 75 years old with GBM status-post tumor resection and radiotherapy Post-surgical changes of a left parieto-occipital craniotomy with underlying dural thickening and enhancement as well as blood products surrounding the resection bed, not significantly changed from prior exam. Foci of enhancement extending from the medial aspect of the resection bed in the parietal lobe to the medial aspect of the left temporal horn, not significantly changed from prior exam. A rim of restricted diffusion surrounds the resection bed and likely represents post-surgical cytotoxic edema. Confluent areas of increased T2/FLAIR signal surrounding the resection bed appears similar to prior exam, however, there is increased T2/FLAIR signal surrounding the left temporal horn with partial effacement of the left lateral ventricle. There is also mildly increased ventriculomegaly. Additional punctate foci periventricular and subcortical T2/FLAIR hyperintensity is non-specific.The pituitary gland appears unremarkable. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1.Post-surgical changes of a left parieto-occiptal craniotomy with areas of enhancement along the anterior aspect of the surgical bed has not significantly changed from prior exam. However, there is increase in the T2/FLAIR hyperintensity extending from the tumor bed adjacent to the temporal horn of the left lateral ventricle (associated with increased ventriculomegaly). Differential considerations include treatment related changes, non-enhancing tumor, or edema / transependymal migration of CSF.2.Since prior exam the lateral third ventricles have enlarged