Female, 56 years old, with history of grade 3 meningioma status post radiation therapy, status post biopsies showing radiation necrosis, with recent development of orbital lesions. Now on steroids. Redemonstrated are surgical findings related to prior wide left pterional craniotomy. Patchy gyriform enhancement with scattered susceptibility along the left frontal brain parenchyma is redemonstrated showing no significant interval change. Ependymal enhancement along the left frontal horn, and a few additional disparate foci of enhancement including within the left posterior temporal lobe, are also unchanged. The degree of white matter T2 hyperintensity associated with the left frontal parenchymal lesions and along the left ventricular atrium is stable to slightly improved.Nodular enhancing tissue is again seen within the left middle cranial fossa with perhaps some extension extracranially into the infratemporal fossa. This lesion appears to incorporate or at least indent the adjacent left temporal parenchyma. This lesion continues to measure approximately 20 x 14 mm in the axial plane and has not significantly changed in size.Redemonstrated is enhancing tissue within the left orbital apex extending posteriorly to involve the cavernous sinus. The overall size of this lesion is stable to slightly smaller when compared to prior examinations measuring up to 12 mm thickness in the coronal plane. Of note, however, the prominent central nonenhancing component which became evident on the prior examination has either filled or collapsed upon itself.
1.Stable pattern of patchy gyriform enhancement and associated parenchymal T2 signal abnormality within the left frontal lobe and, to a lesser extent, a few other disparate left cerebral regions. These findings remain compatible with treatment effect.2.Stable appearance of a nodular region of enhancing soft tissue within the left middle cranial fossa. This lesion could represent either treatment effect or residual/recurrent meningioma.3.A soft tissue process involving the left orbital apex and cavernous sinus shows little if any significant interval change in size. The pattern of enhancement, however, has changed in that the previously seen central hypoenhancing component has either filled in or collapsed upon itself.