 There has been interval expected evolution of previously seen postoperative changes from right temporal craniotomy for partial resection of a mesial right temporal lobe mass. The resection cavity margins are now better delineated, although the cavity is now filled with diffuse homogeneous intrinsic T1 and FLAIR hyperintensity, with marginal mild T2 hypointensity and susceptibility consistent with hemosiderin deposition. The resection cavity demonstrates mild marginal enhancement as well. Medial to the resection cavity, there is again persistent focal oval T2 hyperintensity with peripheral enhancement related to residual tumor in the posterior right parahippocampal gyrus. The rind of enhancement has slightly increased since the prior exam. In addition, there has been interval increased thickness of the rind of enhancement along the anterior area of nodular enhancement extending from the medial aspect of the resection cavity. There is also now new focal nodular enhancement along the more superior medial right temporal lobe as seen on 1001/13. Overall, extent of FLAIR hyperintensity involving the right temporal lobe consistent with the extent of tumor, appears similar to the baseline exam. However, now subtle FLAIR within the splenium of the corpus callosum on the right side, as seen on 401/17, with mild expansion. Relatively mild associated localized mass effect appears similar.Trace fluid is present in the right mastoid air cells. Extracranial fluid collection along the craniotomy flap has significantly decreased in size, with minimal residual fluid along the posterior margin of the craniotomy. There remains minimal extra-axial fluid underlying the flap, measuring 3 mm in greatest thickness
1. Interval expected evolution of previously seen postsurgical changes related to subtotal resection of medial right temporal lobe mass, with interval increased thickness of rind of enhancement in areas of residual tumor as well as new nodular enhancement more superiorly in the heel right temporal lobe. Findings are most suggestive of tumor progression.2. Mild expansion with increased FLAIR signal in the splenium of the corpus callosum on the right side adjacent area of tumor, concerning for tumor progression. Overall extent of FLAIR abnormality involving the right temporal lobe otherwise appears similar to baseline, likely representing a combination of vasogenic edema and nonenhancing tumor.