Female, 43 years old, history of NF2, history spinal schwannoma resection, meningioma, one year follow-up Brain: Redemonstrated is a mildly hemosiderin stained area of encephalomalacia involving the left pons appearing similar to the prior examination. Tract like T2 hyperintensity is seen coursing through the left frontal lobe, also unchanged compatible with prior instrumentation. No evidence of mass effect is seen. No abnormal fluid collections are detected. Ventricles are normal in size and morphology.Multiple areas of dural thickening and enhancement are again demonstrated including a plaque like region along the anterior right frontal convexity, as well as more nodular areas along the high right convexity, the anterior interhemispheric falx, along the right transverse sinus, and the left tentorial leaf. There is stable to minimal enlargement compared to prior. For example a left tentorial lesion measures 8 x 14 mm, previously 6 x 12 mm.A nodular enhancing lesion within the right IAC measures 10 x 5 mm, previously 8 x 5 mm. An enhancing nodule in the left IAC measures 14 x 8 mm previously 12 x 6 mm.A small enhancing nodule in the right parietal scalp measuring 8 x 5 mm, previously also 8 x 5 mm.Cervical Spine: Spinal lesions are as follows:1. Extramedullary intradural lesion within the left posterolateral thecal sac at C1 measuring 9 x 5 mm, previously 8 x 5 mm.2. Right C2-3 foraminal lesion measuring 16 x 8 mm, previously 13 x 10 mm. Minimal extension into the right lateral aspect of the epidural space without mass effect on the cord. 3. Left C3-4 foraminal lesion measuring 26 x 10 mm, previously 25 x 10 mm. The more medial intraspinal component measures 10 mm in the oblique dimension, previously 7 mm. The enlargement involving the medial intraspinal component results in mass affect on the cord which is stable to minimally worse.As above, the spinal cord is impinged at the C3-4 level, but at no point is there any evidence of increased cord T2 signal to suggest edema.The cervical lordosis is mildly reversed. Vertebral body heights are preserved. Marrow signal characteristics are unremarkable.There remains a disk osteophyte complex asymmetric towards the right at the C5-6 level which results in at least mild spinal canal stenosis and impression on the ventral cord; there is also mild right greater than left neural foraminal stenosis. Minimal T2 hyperintensity within the right ventral aspect of the cord at this level is suspected and possibly also present previously; finding may represent myelomalacia.Numerous small nodular lesions within the soft tissues of the neck which may reflect lymph nodes or nerve sheath tumors appear similar to prior.Thoracic Spine:Redemonstrated is evidence of posterior approach surgery with changes spanning from T3 to T7 for resection of a previously noted schwannoma at the T6 level. No evidence of residual tumor is seen in the operative region. Subtle foci of nodular enhancement are seen along the ventral aspect of the thoracic cord at the T6-T7 level on the sagittal images and not well appreciated on the axial images. These are not seen on the prior study. T2 hyperintensity within the cord is noted at T6 compatible with myelomalacia and present previously.At the T12 level, an enhancing extramedullary intradural mass is redemonstrated in the right lateral aspect of the thecal sac measuring 6 x 4 x 8 mm, previously 5 x 5 x 7 mm.Alignment is anatomic. Vertebral body heights are preserved. No concerning marrow replacement is seen. No significant spinal canal or neuroforaminal stenosis is detected.Lumbar Spine:Intradural lesion within the posterior left aspect of the distal cord surface at L1 measures approximately 5 x 4 mm, previously 5 x 4 mm. Intradural enhancing lesion nearly filling the thecal sac at the L3-4 level measures 10 x 12 x 13 mm, previously 10 x 11 x 12 mm. This lesion displaces the adjacent nerve roots of the cauda equina posteriorly and laterally.The lumbar lordosis is slightly straightened. Alignment is otherwise unremarkable. Vertebral body heights are normal. No concerning marrow signal alteration is demonstrated.Mild degenerative disk disease seen at L3-4 without significant degenerative spinal canal or foraminal narrowing. Moderate degenerative disease is seen at L4-5 and L5-S1 with disk bulging and facet hypertrophy resulting in mild thecal sac narrowing and at most mild foraminal narrowing, not significantly changed.
1. Multiple areas of nodular or plaque-like dural thickening are redemonstrated compatible with meningiomas and stable to minimally larger than prior from 6/23/2014.2. Encephalomalacia in the left pons is unchanged.3. Bilateral vestibular schwannomas are reidentified and are minimally larger than prior.4. A mass within the right C2-3 neural foramen is not significantly changed. Minimal epidural extension without mass effect on the cord again seen.5. A mass centered in the left C3-4 neural foramen with intraspinal extension has slightly increased in size with stable to slight worsening in mass effect on the adjacent cervical cord. No associated cord signal abnormality. 6. Disc osteophyte complex at C5-C6 with mild impression on the right ventral aspect of the cord and small focus of associated cord signal abnormality which may represent myelomalacia. No significant change since prior.7. Redemonstration of surgical sequelae following resection of a previously seen posterior intradural lesion at T6. No evidence of recurrent tumor is seen at this site. There remains some abnormal T2 signal in the cord at this level which likely reflects myelomalacia and which is unchanged. There is however nodular enhancement at the T6-T7 level along the ventral aspect of the cord seen only on the sagittal images which may be related to a new lesion and can be assessed on follow-up studies.8. Remaining lesions in the thoracic and lumber spine are stable to minimally larger as above. Largest of these is at the L3-L4 level and fills the thecal sac.