52 years, Male, history of renal cell carcinoma and brain metastasis, status post craniotomy for resection. Planning for stereotactic radiosurgery. Examination is obtained for stereotactic radiosurgical planning and limited to SWI and post gadolinium 3-D T1 sequences.Again seen are postoperative findings related to recent right frontotemporal craniotomy for resection of 2 metastatic right frontal lesions. There is interval evolution of postsurgical changes including decreasing blood products in the resection cavity. Again seen is surrounding vasogenic edema with associated mass effect including lateral ventricular effacement and leftward midline shift of 7 mm, which is slightly improved in the interval. The basal cisterns are preserved. There is mildly increased enhancement along the resection cavity margin without discrete mass appreciated. This finding is suboptimally evaluated due to the absence of precontrast T1-weighted images.There is focus of susceptibility effect in the right cerebellar hemisphere (image 50 or series 3) with minimal enhancement, with enhancement better appreciated on prior study from 9/14/2015. There is also a punctate, less than 2 mm enhancing focus in the left inferior cerebellar hemisphere, axial image 21 of series 4. No new lesions.
1. Interval evolution of postsurgical changes of right frontotemporal craniotomy for resection of two right frontal lesions. No residual tumor in the right frontal lobe is appreciated.2. Unchanged two punctate foci of abnormal enhancement in the bilateral cerebellar hemispheres, with associated susceptibility effect in the right-sided lesion, which may represent additional metastases. 