Clinical question: Preoperative planning for seizure examination. Signs and symptoms: Seizure. Pre and post infusion brain MRI:Examination is performed utilizing surgical/treatment planning protocol and is not a true diagnostic test. There is no detectable abnormal parenchymal or leptomeningeal enhancement.There is a linear focus of T2 hypointensity extending from the inner table of left stereotactic bone across the brain parenchyma and terminating in the medial aspect of the left anterior temporal lobe representing track of surgical ablation device. Small loculated focus of T2 hyperintense and T1 hypointense along the medial aspect of the left mid temporal lobe deep to represent focus of surgical ablation for seizure. This finding measures approximately at 11 x 14 mm in transaxial dimensions.Unremarkable study otherwise.New since prior exam there is a focus of T2 hyperintensity and T1 hypointensity in the left anterior frontal lobe involving the cortex and subcortical white matter which is best appreciated on axial series 201 on images 125 through 141 which is at the sites of previously placed surface electrodes. There is subtle superficial enhancement which may represent a meningioma scarring.Postoperative changes of a left anterior temporal craniotomy is also noted. Ventricular system remains within normal and with maintained midline.
1.Focus of encephalomalacia in left anterior frontal lobe is new since prior exam.2.No acute intracranial process.3.Expected postoperative changes of laser ablation in the left medial temporal lobe.