Preoperative planning: glioblastoma. There are prior postoperative findings related to biopsy of a rim-enhancing mass centered in the right temporal stem and posterior right insula that measures up to approximately 5 cm, with multiple adjacent smaller peripherally-enhancing nodules and extensive surrounding edema involving right thalamus, right middle cerebral peduncle, right basal ganglia, and right parietal lobe. There are areas of T2 hyperintensity in the right parietal lobe white matter without corresponding enhancement. There is effacement of the temporal horn of the right lateral ventricle and most of the third ventricle, but prominence of the left lateral ventricle. There is 10 mm of midline shift to the left. There is no evidence of acute infarct. The major cerebral flow voids are intact. There is prominence of the bilateral optic nerve discs and optic nerve sheath cerebrospinal fluid, which is suggestive of raise intracranial pressure. There are retention cysts in the left maxillary sinuses. There are skin fiducial markers.
Preoperative planning MRI demonstrates a dominant necrotic mass centered in the right temporal stem and posterior right insula, with multiple satellite lesions, compatible with high grade glial neoplasm. The mass effect is associated with 10 mm of midline shift to the left and obstructive hydrocephalus. 