Male, 16 years old, history of neurofibromatosis type II with acoustic neuroma and intracranial meningiomas, spinal cord lesions, status post cervical tumor debulking. Brain:Sequela of multiple prior craniotomies are again seen. Scattered areas of encephalomalacia in both frontal lobes are unchanged. The CSF space along the left lateral cerebellar hemisphere remains widened similar to prior.No restricted diffusion or parenchymal edema is suspected. No new intracranial hemorrhage or extra-axial collections are seen. Scattered areas of susceptibility artifact are unchanged and likely reflect a combination of calcification and chronic blood product. Ventricular size and morphology are stable.Multiple intracranial masses are demonstrated with details as follows:1. A bulky right CP angle/IAC tumor seems to slightly increased in size, at least along its inferior aspect, where it measures 34 x 22 mm (image 8 series 201) previously 32 x 20 mm.2. A left CP angle tumor also seems to have increased slightly in size measuring 16 x 10 mm (image 9 series 2 on), previously 12 x 8 mm.3. Residual enhancing tumor along the surgically altered left IAC and within the temporal bone centered at the geniculate ganglion may be slightly more prominent than on the prior examination, but comparison is difficult due to differences in technique.4. Tumor along the bilateral cisternal trigeminal nerves, with probable involvement of the cavernous sinuses, is unchanged.5. A small intraconal mass along the left lateral rectus muscle has probably not significantly changed.6. A tumor along the planum sphenoidale is at most minimally enlarged measuring 18 x 14 mm (image 34 series 302), previously 17 x 12 mm.7. Enhancing lesions in the left parietal scalp and right suboccipital scalp are not convincingly changed.8. A cystic and solid lesion with mild associated enhancement in the left brachium pontis is minimally increased in size with slightly more prominent enhancement.Spine:Postop findings are again seen with evidence of multilevel cervical laminectomy and partial resection of a cervical spinal cord tumor. Since the prior examination, postoperative findings including fluid and air within the soft tissue resection bed have resolved. T2 hyperintensity extending through the cervical cord has also significantly improved with only mild residual scattered T2 hyperintensity.Nodular intramedullary tumor at the cervicomedullary junction has slightly increased in size now measuring 20 x 16 mm in cross-sectional dimensions, previously 19 x 14 mm.Numerous enhancing tumors are seen along the cervical nerve roots including small lesions along the intradural portions of the nerves, for example at the C3 level on the left, at the C1-2 level bilaterally and along the foramen magnum on the left. These lesions were present on the prior examination but are better seen on today's study which could reflect differences in technique or very slight increased size.Also redemonstrated are bulky foraminal tumors which expand the neural foramina bilaterally beginning with the C5-6 neural foramina and continuing down. The lesion on the left at C5-6 projects from the foramen into the intradural space. All these lesions appears slightly larger than on the prior exam.In the thoracic region, a very bulky foraminal and extraforaminal tumor on the right at T2-3 has increased in size now measuring 54 x 33 mm (image 20 on series 4101) previously 47 x 32 mm. An intramedullary tumor at the T6 level has increased slightly in size. Two or three small extramedullary intradural nodules on the left at the T6 level have not convincingly changed. Additional small intradural nodules at lower thoracic levels have not significantly changed.Innumerable small nodules along the nerve roots of the cauda equina are seen. Some of these may be mildly increased in size relative to the prior examination, but overall, there has been no substantial change. A nodule along the lumbar plexus on the right at the L4 level is probably mildly increased in size measuring up to 14 mm in thickness, previously 12 mm.
1. Multiple intra-cranial masses are redemonstrated representing a mixture of presumed schwannomas and meningiomas. Most of these lesions demonstrate a mild interval increase in size. 2. An intramedullary lesion within the left brachium pontis may be minimally larger with slightly more prominent enhancement. 3. Redemonstration of findings related to partial resection of a tumor from the upper spinal cord. Residual nodular tumor at the cervicomedullary junction has increased in size.4. Scattered innumerable intradural, foraminal and extraforaminal tumors are redemonstrated throughout the spine, many of which have increased slightly in size.5. An intramedullary lesion at the T6 level has also increased in size.