Clinical question: History of meningioma. Evaluate residual for growth. Signs and symptoms: None surveillance imaging 3 months postop. Pre- and post enhanced brain MRI:Negative diffusion-weighted images.There is interval significant improvement of postoperative changes of a large bilateral anterior frontal craniotomy. There is resultant interval resolution of extra-axial fluid and air collection in bilateral anterior cranial fossa and complete resolution of bilateral frontal vasogenic edema.There is interval development of encephalomalacia of the bilateral anterior and inferior frontal lobes and with resultant ex vacuo dilatation of the frontal horns of lateral ventricles.There is evidence of uniformly enhancing mass along the planum sphenoidale measuring 19 mm in AP axis and 8 mm in height (sagittal post enhanced series 1/3/2001 image 13 which has decreased since prior MRI exam from 2-23-20 which measured 28 x 10 mm. Note should be made that MRI examination from 2-25-15 were dedicated study of the orbits and midline of the anterior cranial fossa where the tumor resides was not well-visualized.Additionally there is a mass in the midline extending from the planum sphenoidale in the superior anterior axis consistent with additional foci of residual tumor measuring at 23 x 11 mm measured on sagittal post enhanced series 1301 on image 13. Compared to prior exam from 2-23-15 30 significant interval decreased size of this lesion which measured at 29 x 22 mm.The anatomical morphology and signal intensity of brain remains within normal on all MRI sequences otherwise without change since prior exam.Extensive isointense to hypointense T1 and hyperintense T2/T2 FLAIR with enhancement in the bilateral frontal sinuses are believed to represent postoperative packing and enhancement. .
1.Examination is compared with prior dedicated brain MRI exam from 2-23-15 and cannot be properly evaluated compared to exam on 2-25-15 which was a dedicated orbital MRI exam.2.There is interval decreased size of residual meningioma along the planum sphenoidale measuring at 19 x 8 mm (sagittal post enhanced series) compared to prior dedicated brain MRI study measurement of 28 x 10 mm. Additional focus of residual tumor in the midline and extending from planum sphenoid superiorly measuring at 23 x 11 compared to prior study measurement of 29 x 22 mm.3.Significant interval resolution of postoperative changes and near complete resolution of bilateral anterior and inferior frontal lobes and development of significant bilateral frontal encephalomalacia.