Reason: hx crani for parafalcine Meningoma. eval for change/recurrence History: none Postoperative changes are again seen from previous frontal craniotomy for resection of a right parafalcine meningioma. Extent of T2/FLAIR hyperintense gliosis along the posterior aspect of the right superior frontal gyrus and cingulate gyrus remain similar, as does associated susceptibility relating to chronic hemosiderin. Again noted is a small area of enhancement along the anteromedial aspect of the resection cavity. Allowing for differences in technique, this likely has not significantly changed since the May 2012 exam. On coronal images, it has a somewhat stellate appearance except for the most rightward component as seen on 1101/102, where it appears more nodular. This component measures 3 mm transverse on 1101/102, compared to previous 2 mm on prior 1100/49 in November 2012. Evaluation is also limited due to presence of surrounding enhancing vessels. It overall measures 8 x 6 mm, essentially not significant changed since the May 2012 exam.There is redemonstration of scattered punctate foci of T2/FLAIR hyperintensity within the white matter which remains stable, likely relating to chronic small vessel ischemic changes.The ventricles and sulci are within normal limits for age. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.There is a persistent right maxillary sinus mucosal retention cyst. There is partial opacification of the left frontal sinus.
Allowing for differences in technique, no significant interval change in size of a small enhancing nodular focus along the anteromedial aspect of the right parafalcine resection cavity, comparing back to May 2012. Differences in measurement may relate to slice selection and/or differences in technique. Findings are overall favored at least in part to represent granulation tissue, although continued follow-up is recommended as the right lateral component is slightly rounded in contour with perhaps subtle increased prominence since November 2012, although the finding overall appears stellate on coronal imaging.