Status post right craniotomy for cavernoma resection. There are new postoperative findings related to right pterional craniotomy for resection of a large cavernous malformation in the right basal ganglia and medial temporal lobe. There appears to be grossly total resection of the lesion. There is susceptibility lining the resection cavity related to chronic hemosiderin staining with local postoperative products in the resection cavity. There is a small amount of right extra-axial fluid and pneumocephalus, as well as minimal intraventricular blood products. There is decreased mass effect on the right medial temporal lobe. There is minimal restricted diffusion with associated T2 hyperintensity located superomedial to the resection cavity and involving the body of the caudate, compatible with cytotoxic edema/small infarct. Two additional separate foci of susceptibility located anteriorly and superiorly to the resection cavity appear similar to the prior study, and may reflect additional small cavernous malformations. For reference, a lesion involving the anterior putamen and subinsular region measures approximately 5 mm (series 601, image 19). Scattered predominantly subcortical T2 hyperintensity is nonspecific but compatible with mild small vessel ischemic changes.There is no significant midline shift. The ventricles and basal cisterns are normal in size and configuration. The midline structures and craniocervical junction are within normal limits.Normal flow-voids are demonstrated in the major intracranial vascular structures. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.
1. Expected postoperative findings related to right pterional craniotomy and resection of a cavernous malformation. There appears to be total resection of this lesion with hemosiderin staining surrounding the resection cavity. 2. A small area of restricted diffusion and T2 hyperintensity superomedial to the resection cavity is compatible with cytotoxic edema/small infarct.3. Two additional small areas of susceptibility located anteriorly and superiorly to the resection cavity are suspected to represent small additional cavernous malformations.