Clinical question: h/o atypical meningioma and craniotomy. Findings and symptoms: Surveillance. Pre and post enhanced brain MRI:Negative diffusion-weighted images.Chronic expected postoperative changes of a left anterior frontal craniotomy is noted.There is underlying small focus of encephalomalacia of the left frontal lobe at the site of surgery which remains identical to prior exam from 2014.Post enhanced images demonstrate expected minimal epidural thickening and enhancement at the surgical site however without evidence of residual or recurrence of tumor is a similar observation as prior exam.Additionally examination demonstrate extensive periventricular and subcortical and to a lesser degree bilateral basal ganglia and minimally of right paramedian pontine foci of FLAIR hyperintensity. Findings are nonspecific and remain stable since prior study. Although nonspecific in this age group this appearance could represent chronic small vessel ischemic strokes.Also as was noted on prior exam there is extensive chronic pansinusitis with interval progression of disease since prior study.
1.No acute intracranial process.2.Stable postoperative changes of left frontal craniotomy for removal of meningioma without residual or recurrence.3.Findings suggestive of chronic small vessel ischemic strokes of moderate degree without significant change.4.Extensive chronic pansinusitis with interval progression of disease since prior exam.