42-year-old male, NF 2, status post resection of schwannoma and meningioma. 3 month postoperative evaluation. Brain MRI:Redemonstrated is a contrast-enhancing left acoustic schwannoma, filling the left IAC, extending to involve the vestibule and a portion of the proximal semicircular canals. The largest portion within the left cerebellopontine angle measures 12 mm. These findings are unchanged in appearance.Redemonstrated is a contrast-enhancing right acoustic schwannoma, filling the right before meals, extending to involve the vestibule, semicircular canals, as well as the geniculate ganglion and the right facial nerve (extending along its entirety to the parotid gland). The largest portion within the right cerebellar pontine angle measures 28 mm, which is increased in size from the previous 24 mm. There is greater mass effect upon the adjacent pons, middle cerebellar peduncle, and cerebellum, however without associated edema.There is a dural based enhancing mass underlying the left rectus gyrus which extends inferiorly into the superior-most left ethmoid air cells and adjacent inferior frontal sinus, most likely representing a meningioma. Given differences in technique, there has been no significant interval change.Also redemonstrated are a few, very small foci of enhancing prominence along the falx, probably anteriorly, which are unchanged in appearance. These likely represent very small meningiomas.There are new foci of T2 hyperintensity within the within the white matter, predominantly subcortical in location, without associated restricted diffusion.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The right mastoid air cells are completely opacified by fluid intensity material. There has been prior retinal banding.Cervical spine MRI:Redemonstrated are postsurgical changes of suboccipital craniectomy and resection of the posterior arch of C1. Laminoplasties are also noted from C3 to C6. Again seen are multiple enhancing lesions throughout the cervical spine and partially imaged brain including nodular intramedullary lesions involving the cervical cord within the medulla and at the C1 and C2 levels which may represent ependymomas, unchanged in appearance. These are associated with T2 hyperintensity.Enhancing masses seen involving the right C2 nerve root and a smaller one on the left compatible with schwannomas, unchanged.C2-C3: Enhancing left nerve root with mild expansion of the neural foramina likely represents a schwannoma. There is mild intraspinal extension without significant cord deformity. These findings are unchanged.C3-C4: No enhancing lesions. No spinal or neuroforaminal stenosis. These findings are unchanged.C4-C5: Expansile lesion involving the right neural foramen again seen with intraspinal extension and mild residual mass effect on the right aspect of the cord. Partial resection as described previously. T2 hyperintensity within the right aspect of the cord. Other than slightly more solid enhancement of the medial-most aspect of the right foraminal mass, the findings are unchanged. C5-C6: Large, predominantly extraforaminal lesion on the right. Small enhancing extra foraminal lesion on the left. No spinal canal stenosis. These findings are unchanged. A previously identified postoperative fluid collection at this level has changed in character, now demonstrating T2 hypointensity and heterogeneous enhancement, which is increased in prominence along the posterior aspect of the thecal sac, causing new indentation of the posterior cord although without intrinsic cord signal abnormality. This also extends inferiorly to the C6-7 level, where there is new flattening of the posterior aspect of the cord, again without intrinsic cord signal abnormality.C6-C7: Small, predominantly extraforaminal enhancing lesions bilaterally without expansion of the foramina. No spinal canal stenosis. These findings are unchanged.C7-T1: Small predominantly enhancing extraforaminal enhancing bilaterally lesions without expansion of the foramina, likely unchanged. No spinal canal stenosis. These findings are unchanged.There is a relatively large lesion involving the peripheral aspect of the C6 nerve root extending to the brachial plexus. Additional smaller schwannomas partially visualized within the thoracic spine. These findings are unchanged.Vertebral body heights are normal. Mild focal kyphotic angulation at the C5-C6 level is again seen. Previous demonstration of increased T2 signal at the level of the right hemitongue raising the question of denervation are not appreciated on the current exam given differences in image acquisition.Note is made of a few deposits of fluid signal residing dependently within the visualized trachea. Incidental note is made that previous distention of the internal jugular veins is no longer evident, although they do appear to remain patent.
1.Stable left acoustic schwannoma.2.Enlarging right acoustic schwannoma.3.Probably stable presumed meningioma underlying the left rectus tremors.4.Stable probable small meningiomas involving the falx.5.There are new foci of T2 hyperintensity within the within the white matter, predominantly subcortical in location, without associated restricted diffusion. These are nonspecific, and may represent treatment change and/or small vessel ischemic disease.6.The right mastoid air cells are completely opacified by fluid intensity material. 7.Again seen are multiple enhancing lesions throughout the cervical spine and partially imaged brain including nodular intramedullary lesions involving the cervical cord within the medulla and at the C1 and C2 levels which may represent ependymomas, unchanged in appearance. These are associated with T2 hyperintensity.8.C4-C5: Expansile lesion involving the right neural foramen again seen with intraspinal extension and mild residual mass effect on the right aspect of the cord with associated T2 hyperintensity. Other than slightly more solid enhancement of the medial-most aspect of the right foraminal mass, the findings are unchanged. 9.C5-C6: A previously identified postoperative fluid collection at this level has changed in character, now demonstrating T2 hypointensity and heterogeneous enhancement, which is increased in prominence along the posterior aspect of the thecal sac, causing new indentation of the posterior cord although without intrinsic cord signal abnormality. This also extends inferiorly to the C6-7 level, where there is new flattening of the posterior aspect of the cord, again without intrinsic cord signal abnormality.10.The remaining stigmata of NF 2 within the cervical spine MRI are stable in appearance as described in detail above.