Clinical question: History of craniotomy for meningioma. Evaluate for recurrence or residual. Signs and symptoms: None. 3 months postop surveillance. Pre- and post enhanced brain MRI:No evidence of restricted diffusion.Examination demonstrates postoperative changes of a large left frontal temporal craniotomy. Mild epidural thickening and enhancement under the craniotomy flap is an expected postoperative change. Minimal dural thickening and enhancement beyond the craniectomy flap on the left is also within expected postoperative changes.There is interval resolution of vasogenic edema and mass effect in left temporal lobe as result of resection of tumor. Small focus of FLAIR hyperintensity in the left anterior temporal tip without mass effect and likely representing gliosis is remaining. This finding measures approximately 30 mm in transaxial dimensions. On post enhanced images there is a thick irregular band enhancement along the left greater wing of sphenoid measuring at least 26 mm in transverse axis and 16 mm in AP axis (thickness). This finding demonstrate mixed signal intensity on T2 and FLAIR series. The appearance is suggestive of epidural thickening and enhancement however considering presence of tumor at this site on prior exam possibility of residual tumor cannot be excluded and further follow-up is recommended.
1.Postoperative changes of a large left anterior temporal and frontal craniotomy as detailed above.2.Interval resolution of vasogenic edema and mass effect in left temporal lobe due to removal of meningioma.3.A thick irregular band of enhancement along the greater wing of the sphenoid on the left measuring at 26 mm in transverse and 16 mm in thickness although could represent postsurgical change possibility of residual tumor/meningioma cannot be entirely excluded. Further follow-up is needed. 4.Residual focus of gliosis/encephalomalacia in the left anterior temporal tip is noted.