70 year old male with history of recurrent right posterior parietal meningioma after initial resection (2003). Poor candidate for re-resection, now status post frameless stereotactic radiosurgery. Follow up. Compared to 8/19/2014 there is slight enlargement of extra-axial enhancing mass along the posterior parietal convexity which extends extracranially. There is an osseous defect which is partly postsurgical. Mass measures approximately 5.8 x 3.1 cm (sagittal postgad image 15/27) and 5.1 cm in the transverse dimension (coronal T2 28/34) previously 4.2 cm in the transverse dimension. There is significant interval decrease in the previously necrotic appearance of the tumor with more solid tissue demonstrated on the current study. Extensive gliosis and cystic encephalomalacia involving the right parietal lobe is not significantly changed. Additional areas of T2/flair hyperintensity in the bilateral periventricular and subcortical white matter are also not significantly changed and compatible with chronic small vessel ischemic disease.Again seen invasion of into the superior sagittal sinus with partial occlusion similar to prior with the superior sagittal sinus appearing patent anterior and posterior to the mass. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins. The visualized portions of the paranasal sinuses again demonstrate diffuse opacification of the left frontal sinus as well as some scattered mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1)Compared to 8/19/2014, there is mild interval enlargement of the posterior parietal meningioma which extends extracranially through calvarial defect. There is interval increase in solid component of the tumor and decrease in previously necrosis.2)No significant interval increase in intracranial mass effect. There is extensive gliosis, cystic encephalomalacia, and some vasogenic edema in the right parietal lobe similar to prior. 3)Chronic small vessel ischemic disease. 