Diagnosis: Benign neoplasm of cerebral meningesClinical question: recurrent meningioma status post resection; please evaluate for progressionSigns and Symptoms: recurrent meningioma The patient is status post craniotomy involving both parietal bones and the superior sagittal sinus. There is an extra-axial collection at the craniotomy site measuring up to 13 mm in thickness which was also present on the prior exam. Since the prior exam and this appears to be low more organized. There is associated diffusion restriction within this extra-axial collection. There is adjacent dural thickening which was also present on the prior exam. The dural thickening is more evident on the left versus the right side of the falx. A nodular thickening along the posterior falx currently measures 9 mm x 12 mm and previously measured 9 mm x 12 mm and on sagittal imaging measures 16 x 9 mm on the current exam than on the prior exam measured 12 x 10 mm.Within the brain parenchyma adjacent to the craniotomy site there is signal change within the subcortical white matter in a contiguous fashion which has not changed substantially since the prior exam and has not changed since the preoperative exam.Incidental note is made of partial empty sella.There is mild anterior subluxation of C1 on C2.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate opacification of the right mastoid air cells. The visualized portions of the orbits are intact.
1.Status post parietal craniotomy and superior sagittal sinus surgery for removal of a meningioma. Some residual dural thickening at the surgical site could represent postsurgical change or residual meningioma especially at the junction of the falx and superior sagittal sinus where a nodule appears to be increased in size.2.A fluid collection is present at the surgical site. The possibility this is infected cannot be excluded. Please correlate with patient's clinical symptoms.3.Opacification of the right mastoid air cells and middle ear persists4.There is mild anterior subluxation of C1 on C2 which appears unchanged since prior exam