Male 33 years old with Hx of VHL and multiple hemangioblastomas s/p craniotomy and midline cerebellar mass resection (12/1/15) Post-operative occipital craniotomy with interval resection of midline posterior fossa cerebellar mass. Surrounding cerebellar edema as well as generalized leptomeningeal enhancement is likely post-operative in nature. There is decreased effacement and mass effect on the fourth ventricle and brainstem with the fourth ventricle AP diameter now measuring up to 1.3 cm. A cystic lesion with an enhancing mural nodule anterior and superior to the resection bed is again noted within the midline of the posterior fossa, which measures up to 1.9 cm in AP x 1.7 cm transverse x 1.7 cm in craniocaudal dimension, not significantly changed from prior 1.7 x 1.6 x 1.7 cm accounting for technical differences. Additional enhancing smaller lesions are noted in the bilateral cerebellar hemispheres appear similar in size to prior exam. The right splenium enhancing lesion also appears similar in size to prior exam and measures up to 0.7 cm in AP x 0.7 cm in transverse dimension. There is redemonstration of an enhancing intradural extramedullary nodule at the level C2 in the left thecal sac, which does not cause effacement of the spinal cord and appears stable from prior exam. Linear area of gliosis likely post-operative in nature noted within the right frontal lobe extending to the right lateral ventricle appears stable from prior exam.There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1) Interval suboccipital craniotomy with resection of a midline posterior fossa cerebellar mass with decreased mass effect and effacement of the fourth ventricle and brainstem.2) Additional enhancing lesions in the cerebellum, thecal sac, and corpus callosum appear stable from prior exam and are suggestive of additional hemangioblastomas.