Clinical question: Glioblastoma multiforme. Signs and symptoms: Vomiting. Pre and post enhanced brain MRI:Examination demonstrates a large heavily necrotic and ring-enhancing mass with large areas of solid enhancing component along the medial aspect of right posterior frontal-parietal lobe which inferiorly extends into the splenium of the corpus callosum. The tumor abuts the right lateral ventricle and with resultant inferior displacement. It measures at least at 38 x 35 x 38 mm and consistent with patient's known GBM. The tumor has white contact with the right lateral ventricle and inseparable from its ependymal lining.There is no detectable surrounding vasogenic edema exception of minimal edema in the splenium of the corpus callosum. There is a large focus of encephalomalacia along the interhemispheric aspect of right frontal lobe immediately anterior to the tumor. There is mild dilatation of the lateral ventricles however with maintained midline. Ventricular system however remains stable in size since prior head CT from 8-26-15.There are no additional foci of parenchymal signal abnormality or parenchymal/meningeal enhancement.There is postoperative changes of a large posterior frontal and parietal craniotomy which traverses the midline to the left. As was noted on prior head CT exam there is a large extracranial fluid signal intensity collection immediately superior to the craniotomy and consistent with a seroma. It measures approximately 82 mm in transverse axis and 34 mm in height which are measured on coronal reformatted post enhanced images.
1.Large partially solid and necrotic enhancing GBM along the interhemispheric aspect of the right posterior frontal-parietal lobe as detailed/measured above.There is no significant mass effect and midline is maintained.1.Postoperative changes of a wide parietal craniotomy which extends across the midline to the left and with evidence of a seroma immediately above the craniotomy flap as detailed/measured above.