Per EPIC, history of sinonasal carcinoma status post induction chemotherapy followed by bifrontal anterior fossa skull base approach with frontal bone osteotomy, craniotomy and combined intradural and extradural approach to skull base tumor invading the dura, resection of tumor with complex dural closure with pericranial graft and split bone cranioplasty, microsurgical dissection, harvesting of abdominal fat autograft and insertion of a lumbar subarachnoid drain on March 11, 2010 followed by adjuvant chemoradiation completed July 10, 2010. His course of care has had multiple complications. Patient presents s/p wide local excision of right naso-cutaneous malignant melanoma with skin defect on 6/3/2015 and basal cell carcinoma of the upper lip status post Mohs on 6/9/2015. There is redemonstration of extensive postoperative findings related to skull base surgery, including bilateral frontal craniotomy, resection of the cribriform plate as well as absence of the lamina papyracea, bilateral ethmoids, sphenoid sinus nasal septum and turbinates. There is a persistent rim of tissue in the bilateral maxillary sinuses, stable compared to prior CT from 2014 and slightly improved from MRI of 2012. There is soft tissue thickening subjacent to the frontal craniotomy, which appears increased in size, particularly on the left side compared to CT of 2014 and MRI of 2012. There is heterogeneous tissue or fluid in the sphenoid portion of the operative bed, which shows slightly differing signal characteristics compared to prior MRI of 2012, but is probably stable in extent. Allowing for differences in technique, there are right greater than left anterior frontal foci of T2 hyperintense signal, similar in size compared to to CT of 5/17/2014, although slightly progressed compared to MRI brain dated 9/15/2012. There is a new cystic area associated with the right frontal encephalomalacia. There is mild global parenchymal volume loss, greater than expected for age. There is no evidence of intracranial hemorrhage, or acute infarct. There is no hydrocephalus. There is no midline shift or herniation. There is medial deviation of the bilateral globes.
1. Extensive postoperative findings related to sinonasal surgery.2. Progressive thickening of ill-defined enhancing tissue subjacent to the frontal craniotomy, increased from MRI of 2012 and CT of 2014. The nature of these changes are of uncertain significance and could represent granulation tissue or inflammatory reaction, but progressive disease is not entirely excluded. 2. Progression of right anterior frontal encephalomalacia, which may be related to treatment effect. 