Reason: preop planning for craniotomy- meningioma resection History: preop planning There is redemonstration of the previously seen homogeneously enhancing and rounded extra-axial infratentorial mass in the midline. The mass currently measures 1.7 x 2.0 cm in greatest axial dimensions on 401/70, comparable to previous measurements of 1.7 x 2.2 cm, allowing for differences in technique. Current axial 3-D T2 weighted images suggest the flow-void associated with the straight sinus distally at the level the mass is at least displaced if not invaded with occlusion, with a smaller caliber likely cortical collateral vein identified just to the left of the straight sinus as seen on 301/71-79. The masses dominant centered on the venous confluent and may also involve the medial aspect of the left transverse sinus minimally.A small area of T2 hyperintensity inferior to the left putamen again may be related to a chronic lacunar infarct. Other previously described scattered punctate foci of T2/FLAIR hyperintensity are again suggested and are nonspecific. Mild/moderate age-related volume loss is present. There is no midline shift. There is again extensive diffuse paranasal sinus opacification and mucosal thickening, slightly worsened since the prior exam especially involving the ethmoid sinuses bilaterally.
No significant interval change in size of a midline infratentorial presumed meningioma with suspicion for early invasion of the adjacent dural venous sinuses as detailed above.