47 years Male (DOB:8/24/1968)Reason: s/p crani for tumor resection in oct 2015 History: post-op surveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI brain:The patient is status post left frontal craniotomy. There is surgical tract which extends through the left frontal lobe to the left half of the suprasellar lesion which is associated with T2 signal hyperintensity in the adjacent white matter. There is associated ex vacuo effect on the left lateral ventricle which was not present on the prior exam. There is susceptibility effect along the surface of this surgical tract and along the peripheral aspect of the frontal lobe component of the pituitary mass. There is approximately 2 mm shift of the septum pellucidum towards the right which has significantly decreased since the prior exam. Another component of the mass extends towards the posterior fossa and displaces the right cerebral peduncle. This is also stable compared to the prior exam. Since the prior exam the patient is developing contrast enhancement within the nonenhancing component of the tumor along the suprasellar cistern.There is dural thickening and enhancement along the craniotomy site.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 mastoid air cells are clear. The visualized portions of the orbits are intact.MRI pituitary:There is a mass centered within the pituitary fossa with suprasellar and intraparenchymal extension. It measures 39 x 43 cm in axial dimensions on the current exam and previously measured similar axial dimensions. It is associated with suprasellar extension and a nodular extension into the left frontal lobe. This component extends into the left frontal lobe measures 27 x 30 mm axial dimensions and previously measured 23 x 37 mm dimensions. The mass extends into the cavernous sinuses bilaterally and into the infratemporal fossa and sphenoid sinus. The left internal carotid arteries displaced laterally at the level of the carotid siphon. The mass partially surrounds the ophthalmic segment of the right internal carotid artery. It displaces the anterior cerebral arteries superiorly and displaces the optic nerves and optic chiasm and tracks superiorly. The third ventricle is displaced superiorly and posteriorly. The mass expands the sphenoid sinus and mildly displaces the basilar artery posteriorly.
1.Since the prior exam there has not been a significant interval change in the overall size of the patient's sellar, suprasellar and left frontal intraparenchymal mass. There is, however, some apparent growth of the mass into what appears to have been resected component of the tumor at the suprasellar cistern.2.Since the prior exam there is been evolution of a postoperative changes involving left frontal lobe which now includes gliosis and encephalomalacia. There is less midline shift on the current exam relative to the prior exam.