Reason: hx crani for tumor (meningioma). Yearly follow up for recurrence or change History: none- surveillance. Numerous supratentorial dural based extra-axial lesions consistent with meningiomas are again seen and measured on 3-D postcontrast T1 sequences. Tumors along the falx measure 1.4 x 0.8 cm, 1.2 cm, and 0.7 cm compared to 1.3 x 0.8 cm, 1.1 cm, and 0.6 cm respectively on the prior exam. Smaller lesions along the falx are also noted. A lesion along the right paramedian occipital and posterior parietal lobes measures 1.9 x 1.2 cm, previously 1.8 x 1.2 cm on the prior exam and extends into the superior sagittal sinus with invasion. A lesion along the right posterior frontal lobe measures 1.6 x 1.4 cm, previously 1.3 x 1.1 cm on the prior exam and 1.2 x 1.1 cm on the exam of 8/15/2013. A lesion along the right temporal lobe measures 0.9 x 0.7 cm, previously 0.8 x 0.7 cm. No new lesions are identified. There is a 4 mm focus of enhancement in the left internal auditory canal which may represent a vestibular schwannoma.Postsurgical changes of right-sided craniotomy. Underlying foci of encephalomalacia in the right posterior parietal lobe and right frontal lobe appear similar to the prior exam without evidence of local tumor recurrence. Areas of FLAIR hyperintensity which remain unchanged including surrounding the resection cavity are compatible with gliosis. There is FLAIR hyperintensity associated with the right frontal convexity lesion which is slightly increased compared to prior studies and likely represents mild vasogenic edema. 6 mm focus of susceptibility with associated increased T2 signal in the right posterior temporal lobe is unchanged in size since 2009. Additional punctate focus of susceptibility in the left occipital lobe is unchanged. No hydrocephalus or extra-axial collections. Remainder of the calvarium and extracranial soft tissues are unremarkable.
1.Multiple meningiomas are minimally increased in size as detailed above. Mild enlargement is relatively more notable of the lesion along the right frontal convexity which measures 1.6 x 1.4 cm, previously 1.3 x 1.1 cm on 8/14/2014 and 1.2 x 1.1 cm on the exam of 8/15/2013.2.Posttreatment changes including prior craniotomies and areas of FLAIR hyperintensity largely representing gliosis. There is FLAIR hyperintensity associated with the right frontal convexity lesion which likely represents mild vasogenic edema associated with the adjacent meningioma and minimally increased since prior studies from 2014 and 2013. No midline shift or herniation.3.6 mm focus of susceptibility with T2 hyperintensity in the right posterior temporal lobe is unchanged since 2009 and favored to represent a cavernous malformation. 4.4 mm focus of enhancement in the left internal auditory canal may represent a vestibular schwannoma and remains unchanged.