54 year old female with altered mental status after craniotomy. Post-surgical changes related to bi-frontal craniotomy and and repair of right frontal encephalocele are seen, with pneumocephalus and subcutaneous emphysema consistent with recent procedure. Evidence of bilateral frontal sinus exenteration, with bone fragments and fluid present in expected locations of right and left frontal sinuses. Small amount of extra axial blood is seen in the surgical field overlying the anterior frontal lobes. Increased density overlying the anterior aspect of the superior sagittal sinus may represent blood, however, thrombosis of the sagittal sinus cannot be excluded (series 1, image 18). A small area of hypoattenuation in the right antero-inferior frontal lobe adjacent to surgical site is non-specific and may represent edema related to the surgery, however, focal infarction cannot be excluded.No evidence of intraparenchymal or subarachnoid hemorrhage. There is possibly a trace amount of subdural hemorrhage along the falx.There is crowding at the foramen of magnum related to cerebellar ectopia as seen on prior MRI.There is significant preseptal soft tissue swelling on the right, with associated mild infiltration of the extraconal and intraconal post-septal fat on the medial aspect of the right orbit as well as intraorbital gas superiorly. There is mild right proptosis and apparent stretching of the right optic nerve as well. The left preseptal and post septal soft tissues and intraorbital contents appear unremarkable. No evidence of mass or midline shift.Changes related to right ethmoidectomy and right maxillary antrostomy are seen, with persistent opacification of the partially visulized right maxillary sinus. There is persistent lateral deviation of the right maxillary sinus wall, with opacification and likely packing of the partially visualized right nasal cavity. The left maxillary sinus is partially opacified as well. Ethmoid air cells are opacified bilaterally. The mastoid air cells appear unremarkable. Sphenoid sinuses are partially opacified.
1.Postoperative changes in the anterior calvarium and floor of anterior cranial fossa, with a small amount of extra-axial blood in surgical field and expected pneumocephalus. There is a trace amount of subdural hemorrhage along the falx.2.Increased attenuation in area of anterior aspect of superior sagittal sinus is non-specific and can represent post-surgical changes or blood, however, dural venous sinus thrombosis cannot be excluded. Consider MRI braina and MRV for further evaluation if clinically indicated. 3.Hypoattenuation in antero-inferior aspect of right frontal lobe may be related to post-surgical edema, however, this is nonspecific and infarction in this location cannot be excluded. MRI may be helpful to further evaluate. 4.Soft tissue swelling in the right periorbital region, which also appears to involve post-septal soft tissues; this is concerning for orbital inflammation or infection. Follow-up is recommended; MRI with contrast may be helpful to further characterize.5.Postoperative changes in the right ethmoid air cells and partially visualized right maxillary sinus, with opacification of the maxillary sinuses, ethmoid air cells, and right nasal cavity.