20 years, Male, metastatic germ cell tumor. Preoperative planning for tumor resection. Examination is obtained for surgical planning with fiducial markers in place. Again seen is an enhancing lesion involving the left posterior frontal calvarium and best appreciated on sagittal post gadolinium series 1402 image 36 where it measures 7 mm in thickness and 22 mm in the craniocaudal dimension. There appears to be involvement of the outer table without definite violation of the inner table. Intracranially, there is no evidence of abnormal enhancement or intracranial mass effect. There are multiple foci of susceptibility compatible with chronic hemorrhage involving the bilateral frontal, bilateral parietal, right temporal, and left occipital lobes as well as the left cerebellar hemisphere similar to MRI dated 7/9/2015. No evidence of intraparenchymal edema, mass effect, midline shift, or herniation. No hydrocephalus or extra-axial collections.
1. Examination for operative planning again demonstrates a small left posterior frontal calvarial lesion, best appreciated on sagittal post gadolinium series 1402 image 36 where it measures 7 mm in thickness and 22 mm in the craniocaudal dimension. Lesion appears to involve the outer table without violation of the inner table. Consider CT to better assess the osseous changes.2. Again seen are multiple foci of susceptibility effect throughout the brain compatible with previously seen/treated hemorrhagic metastatic lesions. No abnormal enhancement, edema, or mass effect.