59-year-old female with metastatic melanoma to the brain, planning for stereotactic radiosurgery. Status post craniotomy, tumor resection. Redemonstrated are changes from previous left posterior parietal craniotomy for tumor resection. There has been interval decrease in associated local regional mass effect as well as vasogenic edema. There has been expected evolution of postoperative cavity components, now appearing less T1 hyperintense. There remains hemosiderin staining along the posterolateral aspect of the cavity, associated with T1 hyperintense products which may represent hemorrhage and/or tumor enhancement.There is a new 4 mm nodule of enhancement and susceptibility hypointensity along the lateral cortex of the right superior frontal gyrus (best seen series 401, image 125). This appeared as a pinpoint focus of enhancement on the immediate comparison dated 7/14/2015, and thus has significantly enlarged.Ventricular system remains within normal and with maintained midline.
1.Expected postoperative changes of a left superior parietal craniotomy for tumor resection with decreased mass effect and decreased vasogenic edema.2.There is a new 4 mm nodule of enhancement and susceptibility hypointensity along the lateral cortex of the right superior frontal gyrus. This appeared as a pinpoint focus of enhancement on the immediate comparison dated 7/14/2015, and thus has significantly enlarged and now provides evidence for a second metastasis.3.No other lesions are identified.4.Findings were discussed with Dr. Pitroda on 7/27/2015 at approximately 3:35 AM.