Clinical question: History of meningioma status post resection. Signs and symptoms: Surveillance study. Pre and post enhanced brain MRI:Examination demonstrates chronic expected postoperative changes of a large bilateral anterior frontal craniectomy for removal of tumor. Minimal residual fluid epidural thickening and enhancement is within expected postop changes as well. There are small patchy foci of T2 hyperintense signal changes along paramedian bilateral inferior frontal lobes (L>R) consistent with a small foci of encephalomalacia.Enhanced images demonstrate a tiny well-demarcated focus of enhancement in the right medial midline along cribriform plate measuring 9.5 x 7.4 mm and coronal reformatted series 1001 image 305. Finding is suspected of a tiny focus of residual tumor. Prior MRI exam was performed immediately post surgery and residual post surgical blood product in the surgical bed precludes precise assessment for residual tumor and cannot be compared properly with the current study.The anatomical morphology and the signal intensity of the brain is otherwise within normal on all MRI sequences and without detectable abnormal enhancement.
1.Expected chronic postoperative changes of a large bilateral anterior frontal craniotomy.2.Well-demarcated right paramedian focus of extra-axial enhancement along the right cribriform plate measuring at 9.5 x 7.4 mm coronal postinfusion series is suspected of a small focus of residual tumor. Please see above comments.3.Multiple small foci of encephalomalacia in the bilateral inferior frontal lobes (L>R) likely result of prior tumor and postoperative changes.4.Unremarkable exam otherwise.