Male, 33 years old, for postoperative follow-up of recurrent brain tumor. R frontal GBM s/p resection 2011 (low grade glioma) and 2015 (anaplastic astrocytoma),s/p chemoradiation, now s/p R frontal re-do craniotomy for biopsy and Xiopharm trial virus injection on 12/19. Changes related to right frontal craniotomy are redemonstrated with underlying dural thickening and enhancement. Small amounts extra-axial fluid and air are present over the anterior aspect of the right frontal lobe, similar to postoperative CT. The previously demonstrated prior resection cavity is stable in appearance in the superior right frontal lobe. A biopsy tract from a superior right frontal approach tube deep within the right frontal lobe lesion containing a small amount of subacute blood products and a minimal amount of pneumocephalus is again noted, as on prior CT. Tiny foci of susceptibility artifact are demonstrated within the mass, which may be postprocedural. There has otherwise been no significant interval change in the large region of masslike heterogeneous enhancement (7.2 x 5.6 cm in maximal transverse and AP dimensions) within both frontal lobes and extending across the genu of the corpus callosum. The amount of abnormal T2 signal surrounding the enhancing region is not apparent grossly changed when compared to the examination from 12/19/2016. There is stable effacement of the anterior aspects of the lateral ventricles and mass effect on the corpus callosum. There is no evidence of hydrocephalus. No uncal herniation or significant midline shift is evident. No additional enhancing lesions are identified.There is no evidence of acute infarct. Small mucous retention cysts are again demonstrated in the left maxillary sinus and mucosal thickening is present in scattered ethmoid air cells. The visualized portions of the paranasal sinuses and mastoid air cells are otherwise clear. Major intracranial vascular flow-voids are preserved.
Expected postbiopsy and viral injection changes. Redemonstration of a large bilateral frontal lobe mass extending across the corpus callosum likely related to recurrent tumor.