45-year-old female with a headache status post tumor resection. Epic: History of thyroid and breast cancer status post suboccipital craniotomy 5/3/16 for resection of posterior fossa tumor with microsurgical technique and the intraoperative microscope. Resection of 2 dominant cerebellar masses: 1 near the left inferior cerebellar tonsil and 1 towards the right superior cerebellar hemisphere. Preliminary pathology reveals likely breast adenocarcinoma as the source of metastases. Redemonstrated are post-surgical changes of a recent suboccipital craniotomy for resection of cerebellar metastatic lesions with persistent edema, mass effect on the fourth ventricle, foramen magnum herniation and compression of the brainstem. The enlargement of the lateral ventricles appear are unchanged in size to the prior MRI exam. There is expected post-surgical enhancement along the resection bed involving both the right and left cerebellar hemispheres with expected blood product and small amount of fluid. There is likely residual tumor along the lateral-most aspect of the left cerebellar hemisphere resection cavity, which measures 9 x 13 mm (series 1601, image 88). The multiple remaining additional enhancing lesions are unchanged in size, including a superolateral left cerebellar lesion, which measures 13 x 19 mm, pontine lesion which measures 10 x 16 mm, medial right occipital lobe lesion which measures 8 x 7 mm, right centrum semiovale lesion which measures 6 x 5 mm, middle frontal gyrus lesion which measures 7 x 11 mm, and left inferior frontal gyrus lesion, which measures 4 x 5 mm diameter. There are old post-surgical changes of a left frontal craniotomy. A developmental venous anomaly is again noted in the right frontal lobe. The calvarium has a persistent mottled appearance with foci of the marrow replacement.There is soft tissue swelling along the left fronto-temporal region adjacent to the old left frontal craniotomy site with a skin defect not present on the prior MRI.The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1.Expected post-surgical changes of a suboccipital craniotomy for resection of cerebellar metastatic lesions with persistent edema, mass effect on the fourth ventricle, foramen magnum herniation and compression of the brainstem. There is some residual tumor in the lateral left cerebellar region. 2.The size of the lateral ventricles are unchanged compared to the prior exam.3.Additional multiple lesions compatible with metastatic disease scattered within the brain parenchyma including the pons and supratentorial brain are unchanged.4.Findings consistent with a calvarial marrow replacement for which the possibility of bone metastases cannot be excluded. A bone scan may be helpful.5.Soft tissue swelling along the left temporal scalp adjacent to the old left temporal craniotomy site associated with a skin defect was not present on the prior MRI. Please correlate with clinical exam findings.