 There are postoperative findings related to left parietal craniotomy for resection of a subjacent tumor. There is an unchanged 5 mm thick subjacent subdural fluid collection that does contain foci of susceptibility effect compatible with blood products. The enhancing portion of the tumor along the anterior resection margin measures 15 x 27 mm on coronal plane (series 1202 image 80), previously 13 x 15 mm, and 27 x 18 mm axially (series 1201 image 39), previously 23 x 15 mm. There is a new 5 x 10 mm focus of enhancement medial to the resection cavity. There are some areas of elevated relative cerebral blood volume in the enhancing tissue on perfusion scan. Enhancement along the posterior aspect of the resection cavity has essentially resolved and enhancement along the medial resection cavity margin corresponds to an area diffusion restriction on the immediate postoperative exam and likely represents infarcted tissue. Left temporal lobe superior gyrus resection cavity show increased signal intensity on FLAIR images comparing to prior scan. However, considering there is no visible mass effect nor enhancement on post Gad scans, this is likely represent trapped resection cavity from surrounding CSF space instead of tumor recurrence.The T2 hyperintensity surrounding the resection cavity is essentially unchanged, allowing for differences in technique. The bilateral confluent T2 hyperintensity throughout the supratentorial white matter is also unchanged and is compatible with treatment related changes.There is unchanged apparent hypoplasia of the right cerebellar hemisphere. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.
Findings are concerning for disease progression along the anterior resection cavity margin and medial to the cavity as detailed above. 