55 years, Male, status post meningioma resection. There are postsurgical changes of occipital craniotomy for resection of extra-axial tumor which was abutting the dorsal aspect of the cerebellum. There appears to be near total tumor resection. There is residual extra-axial enhancement abutting/invading the torcular herophili and medial aspect of the right transverse sinus which is suspected to represent minimal residual tumor. This area of enhancement measures approximately 10 x 6 mm. Dural venous sinuses remain otherwise patent. There is restricted diffusion involving the right posterior medial cerebellar hemisphere compatible with cytotoxic edema. Small scattered foci of air as well as small fluid collection with blood products at the resection site and beneath the craniotomy are noted. No large hemorrhage or significant mass effect is appreciated. No midline shift or herniation.Remainder of the brain again demonstrates minimal scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter, which are nonspecific but compatible with mild chronic small vessel ischemic changes. More focal area of T2 hyperintensity involving the left inferior lateral aspect of the putamen is suspected to represent a chronic lacunar infarct and was seen previously. Ventricles are normal in size without evidence of hydrocephalus. Moderate degree of paranasal sinus opacification is again noted.
Near total resection of previously seen posterior fossa extra-axial mass, presumably representing meningioma. Minimal residual tumor is suspected along the wall of the torcular herophili and medial aspect of the right transverse sinus. Venous sinuses remain patent.