NF3: visual field defect, diplopia, and numbness and weakness bilaterally of arms and hands. Orbits: There is slight interval increase in size of the tumor along the right optic nerve sheath that encases and compresses the optic nerve. The tumor now measures 22 mm width and 16 mm in height, previously 20 mm and 14 mm, respectively. The tumor compresses the right medial rectus muscle and results in proptosis. The right globe is otherwise intact. The left orbit is unremarkable. The left parotid and left cheek subcutaneous tumors have not significantly changed. Brain: There are postoperative findings related to right retrosigmoid craniotomy, with encephalomalacia in the right lateral cerebellum. The remaining portion of the right vestibular schwannoma in the right cerebellopontine angle cistern is perhaps minimally larger, measuring up to 9 mm, previously 8 mm. Likewise, the residual tumor within the skeletonized right internal auditory canal appears to be slightly more prominent. There is a 2 mm wide enhancing nodule within the left internal auditory canal, which is more conspicuous. The right geniculate fossa tumor is not significantly changed, measuring 9 x 7 mm in axial cross-section. Likewise, a tumor centered in the right Meckel's cave and along the bilateral oculomotor cisternal segments have not significantly changed. There are multiple supratentorial and infratentorial dural-based enhancing tumors, which do not appear to have changed significantly. For example, the largest tumor along the right frontal convexity measures 18 mm in height and 22 mm in width, previously also 18 mm and 22 mm, perspectively. There are several unchanged punctate foci of T2 hyperintensity in the cerebral white matter. There is no midline shift or herniation. There is no evidence of acute infarction. The ventricles are unchanged in size and configuration. There is a subcentimeter right ethmoid retention cyst.Cervical Spine: There is an enhancing extramedullary mass within the left aspect of the spinal canal at C4-5 with marked compression of the spinal cord. The tumor extends through the left C4-5 neural foramen and along the brachial plexus. The tumor measures up to 15 mm in width and 45 mm in length and displaced and perhaps narrows the left vertebral artery flow void. There minimal T2 hyperintensity within the spinal cord at the C4-5 level. There is also an enhancing lesion within the right C5-6 neural foramen. In addition, there is a 3 mm wide enhancing nodule within the left spinal canal at the C2-3 level. There are dural-based enhancing lesions along the posterior spinal canal at the C2 level that measure up to 3 and 5 mm in thickness and indent the spinal cord. There also appears to be a punctate posterior dural -based lesion at the C5 level, with minimal mass-effect upon the spinal cord. The cervical spine alignment is straightened in the sagittal plane, but there is no spondylolisthesis. The vertebral body hei8ghts are preserved.
1. Stigmata of neurofibromatosis type 2 with multiple intracranial meningiomas that appear to not have significantly changed, cervical spine meningiomas, a right optic nerve sheath meningioma that has slightly increased in size, multiple intracranial schwannomas, including slight increase in size of the residual right vestibular schwannoma and a punctate left vestibular schwannoma, and a large schwannoma at C4-5 that compresses the spinal cord and extends beyond the left neural foramen. The posterior spinal canal meningiomas at the C2 level also indent the spinal cord.2. Unchanged nonspecific cerebral white matter lesions, but no evidence of acute infarct.