40 years, Male, right arm weakness, postop tumor resection. There are postsurgical changes of left-sided craniotomy for resection of previously seen hemorrhagic lesion in the left frontal lobe. There is no definite evidence of any residual tumor in this location although due to the extensive hemorrhagic nature of this lesion and relative lack of appreciable enhancement, assessment is slightly limited. There are blood products in the resection bed which are likely postoperative. Additional expected postsurgical changes include small amount of pneumocephalus as well as edema and emphysema involving scalp. There is edema surrounding the resection cavity similar to prior. There is minimal restricted diffusion surrounding the resection cavity compatible with blood products and minimal if any cytotoxic edema. Again seen is hemorrhagic lesion involving the body of the right lateral ventricle and abutting the septum pellucidum which is suspected to represent an additional metastatic focus. There are small amount of layering blood products in the right occipital horn, which were present preoperatively. There is no significant midline shift or herniation. No hydrocephalus. Unchanged opacification of the left maxillary sinus.
1. Expected postsurgical changes of resection of hemorrhagic left frontal lesion. Due to the extensive hemorrhagic nature of the lesion and relative lack of appreciable enhancement preoperatively, assessment for residual tumor is slightly limited. There is however no clear evidence of residual tumor in the left frontal lobe.2. Hemorrhagic intraventricular lesion along the septum pellucidum is again seen and suspected to represent an additional metastatic focus.