Female, 19 years old, history of recurrent disseminated glio-neuronal tumor status post chemotherapy and radiation. Brain:Redemonstrated are findings related to left temporal craniotomy and tumor resection. The size and morphology of thickened T2 hyperintense tissue within the operative region has not significantly changed. Also unchanged is mild encephalomalacia effecting the pars orbitalis, and periventricular T2 hyperintensity along the left lateral ventricle, both likely related to prior treatment. Ex vacuo dilatation of the left lateral ventricle is unchanged.On postcontrast images, enhancing tissue along the left cavernous sinus, with extension into the prepontine and suprasellar cisterns, has not significantly changed in size or extent measuring 26 x 8 mm. More mild lobular enhancement which extends laterally into the left middle cranial fossa is also unchanged.Diffuse leptomeningeal enhancement persists including along the undersurface of the frontal lobes, the paramedian frontal sulci, left greater than right sylvian fissures, along the superior medullary vellum and vermian fissures, as well as along the ventral surface of the brainstem. Enhancement within the internal auditory canal, and along the cisternal optic nerves, is likewise unchanged.Spine:Areas of leptomeningeal enhancement along the right central cord at C2, and dorsally at C7-T1, are unchanged. No spinal cord edema is seen.Multiple areas of leptomeningeal enhancement in the thoracic region are also unchanged, including a plaque-like area along the right dorsal cord at T3, spinal root enhancement at T6, nodular right posterior cord enhancement at T12, and multiple smaller questionable areas of leptomeningeal enhancement from T8 through L1. No spinal cord edema is seen.Enhancement of vascular structures anterior and posterior to the conus is somewhat more prominent than on the prior examination, but this could also be technical. Thick enhancement within the central spinal canal and nerve root sheaths is not appreciably changed.A left paracentral disk protrusion at L5-S1 is stable. Mild bulging disk at C3-4 is also unchanged. No areas of significant canal or neuroforaminal stenosis are seen.Spinal alignment is unremarkable. Vertebral body morphology and signal characteristics are normal.
1.Intracranial findings are stable including areas of lobular soft tissue thickening within the left middle cranial fossa operative region, and fairly diffuse leptomeningeal enhancement.2.Stable leptomeningeal disease in the spine.