Male, 77 years old, history of forehead squamous cell carcinoma status post CRT. Postoperative findings are again seen compatible with left orbital exenteration with soft tissue flap repair, left frontal craniectomy with cranioplasty, left uncinectomy and ethmoidectomy, and resection of the left nasal turbinates.These postoperative alterations show no significant interval change. A layer of debris is evident within the left maxillary sinus which was not present previously. The left maxillary sinus demonstrates thin peripheral mucosal thickening which is similar to prior.Dural thickening subjacent to the cranioplasty is stable and within expected postoperative limits. More inferiorly, thickened enhancing tissue within the orbital exenteration bed, which wraps along the undersurface of the soft tissue flap as well as around and back along the posterior exenteration cavity, shows no significant interval change favoring this to be a postoperative phenomenon.Patchy ill-defined enhancement seen on the prior examination within the left frontal lobe, immediately subjacent to the craniectomy bed, has decreased in conspicuity.Also noted is a generalized decrease in left frontal lobe edema. There remains diffuse ill-defined T2 hyperintensity within the left frontal parenchyma, but the frontal horn of the left lateral ventricle has reexpanded.Some generalized progression of periventricular T2 hyperintensity is seen, favored to represent a treatment related change. No other pathologic parenchymal enhancement is detected.Numerous small parenchymal defects are evident within the cerebral white matter, the deep gray nuclei, and the cerebellum, perhaps representing prior small vessel ischemic lesions. Encephalomalacia and hemosiderin staining in the right parietal lobe and to a lesser extent in the right occipital lobe likely represent chronic territorial ischemia. A new small focus of apparent restricted diffusion is seen within the white matter immediately above the left lateral ventricle. No other restricted diffusion is seen.
1.Stable postoperative findings including left orbital exenteration with soft tissue flap repair, left frontal craniectomy and cranioplasty, as well as left sinonasal resection.2.Thick enhancing tissue within the orbital exenteration bed is unchanged and favored to represent a postsurgical phenomenon. Previously seen patchy enhancement within the left frontal parenchyma subjacent to the craniectomy has decreased in conspicuity.3.Generalized left frontal edema has improved. A mild interval increase in extent of ill-defined periventricular T2 hyperintensity is seen, favored to represent a treatment related effect.4.A small focus of restricted diffusion just above the left lateral ventricle may indicate an acute or subacute incidental small vessel ischemic lesion, or an ischemic sequela of therapy.