Reason: s/p crani History: ha The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior exam, the patient has undergone right sided craniotomy for removal of a middle cranial fossa and right anterior cranial fossa extra-axial mass. Residual T2 signal hyperintensity is present in the pattern suggestive of vasogenic edema in the adjacent right temporal lobe and right internal capsule. The extent of signal hyperintensity is stable compared to the preoperative exam. A couple new centimeter sized gyral T2 signal hyperintensities are present in the right frontal lobe and the right middle frontal gyrus and the orbital gyrus.Midline shift of the septum pellucidum to the left on the coronal imaging at the level of foramina of Monro is currently 11 mm and was previously 8 mm. There is redemonstration of uncal herniation. The sylvian fissure is displaced superiorly.There is some enhancing meningeal based tissue in the right middle cranial fossa measuring up to 7 mm in thickness at the anterior aspect of the right middle cranial fossa. There is dural thickening along the dura in the right calvarium.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Status post recent right sided removal of a meningioma centered in the right middle cranial fossa with associated post-operate changes. There is residual dural thickening at the anterior aspect of the right middle cranial fossa which may represent a small amount of residual neoplasm. A follow-up MRI may help further assess for this.2.Mild increase in midline shift. Please correlate with the patient's clinical symptoms.