17-year-old male with history of neurofibromatosis type II. Brainstem ependymoma, spinal tumors, acoustic neuroma. Six-month follow up. Brain / Internal Auditory Canal:Numerous extracranial enhancing lesions are not significantly changed in size or number. The left frontal scalp lesion measures 12 mm and the right tongue lesion measures 7 mm, previously measuring 12 and 7 mm, respectively.Bilateral enhancing lesions in the internal auditory canals are compatible with vestibular schwannomas and stable from the previous exam. Again seen is abnormal enhancement of the right facial nerve canal, unchanged.Lesion arising from the left cavernous sinus is also unchanged, measuring 21 x 18 mm from previously 21 x 17 mm, and may represent a schwannoma of the trigeminal nerve versus meningioma. An enhancing nodular lesion anterior to the right midbrain is again unchanged at 4 mm and may represent a right oculomotor nerve schwannoma. Enhancement of the left oculomotor is also unchanged.Plaque-like area of dural enhancement along the left frontal lobe likely represents a meningioma, unchanged.No extra-axial fluid collection is identified. There is no diffusion restriction to suggest acute infarct. The ventricles and sulci are within normal limits. The cerebellar tonsils are in normal position. Pituitary gland is unremarkable. Normal flow-voids are demonstrated in the major intracranial vascular structures. Paranasal sinuses and mastoid air cells are clear. Complete spine:Cervical spine:Post surgical findings related to midline suboccipital craniectomy are redemonstrated. There is an enhancing brainstem mass in the caudal medulla extending to the upper cervical spinal cord, measuring 17 mm in craniocaudal dimension. There are at least 4 nearly confluent, enhancing lesions of the upper cervical spinal cord spanning 37 mm from the C2 to C4 levels. Two small dural-based lesions extend from the posterior dura at T2 and T2-3. Bilateral cervical neuroforaminal enhancing lesions at nearly every level are grossly unchanged; the largest measures 16 mm in craniocaudal dimension at the C4-5 left neural foramen. Multiple scattered enhancing cervical soft tissue lesions, including in the carotid sheaths bilaterally. These findings are all stable in size and appearance. Thoracic spine:In the thoracic spine, three small dural based enhancing masses are redemonstrated posteriorly at the right T2 and left T2-3 levels and anteriorly at the left T6-7 level. Patchy T2 hyperintensity with associated cord expansion at T8, T9-10, and T11 is again noted with associated enhancement at T11. Multiple enhancing foraminal, paraspinal lesions, intercostal, and chest wall lesions are again noted. These findings are not significantly changed from the previous exam.Lumbar spine:Again seen is transitional lumbosacral anatomy, with lumbarization of the sixth rib-free lumbar appearing vertebra, designated S1. Spinal cord terminates at the upper L1 level with intact conus medullaris. Numerous enhancing lesions within the lumbar thecal sac are grossly unchanged in size and number. Again seen at the mid L2 level is an extramedullary intradural enhancing mass, also unchanged measuring approximately 8 mm. Numerous enhancing lesions in the neural foramina are stable in size and number, the largest measuring 15 mm in the right S1-2 neural foramen and 12 mm in the left L4-5 neural foramen. Multiple paraspinal enhancing lesions are also unchanged.A large T1 dark/T2 bright mass inferior to the right adrenal gland demonstrates continued growth, markedly increased in size since exam dated 10/2/2013. There has been interval change in signal characteristics from the last exam; lesion was previously solidly enhancing and is now cystic with a thick enhancing rim and enhancing internal septations. The mass measures 4.0 x 3.0 cm axially from previously 2.7 x 2.0 cm.
1.Large mass inferior to the right adrenal gland demonstrates continued growth and interval change in signal characteristics. Findings are concerning for malignant degeneration of a nerve sheath tumor.2.No significant interval change in numerous suspected intracranial nerve sheath tumors and/or meningiomas.3.No significant interval change in enhancing parenchymal tumors of the brainstem and cervical spinal cord.4.Multiple stable thoracic and lumbar dural based enhancing lesions probably representing meningiomas.5.Numerous neuroforaminal and innumerable extraspinal enhancing nodules probably representing nerve sheath tumors, not significantly changed in size or number.6.Enhancing nodules along the cauda equina nerve roots also likely representing nerve sheath tumors.