Status post resection of schwannoma and meningioma, NF, follow-up. Again seen are postsurgical changes of C3-C6 laminectomies related to resection of a relatively large right sided schwannoma at C4-C5 with intraspinal extension. The intraspinal component has been resected with residual tumor within the neural foramen and lateral aspect of the spinal canal at the C4-C5 level not significantly changed.Again seen is extensive cord signal abnormality involving the left aspect of the cord at the C6-C7 level which demonstrates evolution since the recent two postoperative studies. There is also extensive signal abnormality involving the dorsal columns of the cervical cord which extends from the C4-C5 to the mid C6 level which was present on recent studies but slightly more well-defined on the current study, perhaps related to technique.Small enhancing intramedullary lesions are again seen within the cord at the C1-C2 and mid C2 levels which are not appreciably changed.Enhancing mass is present at the right C1-C2 level with intraspinal extension and effacement of the right lateral thecal sac which is similar to prior.C2-C3: No spinal canal stenosis. Enhancing left nerve root with mild expansion of the neural foramen. There is an adjacent extramedullary lesion involving the left anterolateral aspect of the spinal canal without significant mass effect on the cord as before and appears contiguous with the aforementioned left foraminal lesion.C3-C4: No enhancing lesions. No spinal or neuroforaminal stenosis. C4-C5: Partial tumor resection with residual tumor involving the right lateral aspect of the spinal canal and right neural foramen. There is minimal if any residual mass effect on the cord. C5-C6: Large, predominantly extraforaminal lesion on the right unchanged. Small enhancing extra foraminal lesion on the left is unchanged. No spinal canal stenosis.C6-C7: Small,predominantly extraforaminal enhancing lesions bilaterally are unchanged unchanged. No spinal canal stenosis.C7-T1: Small predominantly extraforaminal enhancing lesions without expansion of the foramina, likely unchanged. No spinal canal stenosis.There is mild retrolisthesis of C3 on C4 and anterolisthesis of C4 on C5 as seen before. Focal kyphosis at the C5-C6 level is also again seen. Vertebral body heights are maintained. Bone marrow signal is benign. Limited images of the brain again demonstrates an enhancing lesion likely representing schwannomas at the right jugular foramen. Small extra-axial lesion along the left anterolateral surfaces of the medulla is also again noted which may represent a meningioma.
1. Interval evolution of signal abnormality seen on recent studies at the left C6-C7 level compatible with cord injury. Additional signal abnormality involving the dorsal columns of the cervical cord from the C4-C5 to the mid C6 level was also present on recent studies but is slightly more well-defined on the current study.2. Stigmata of neurofibromatosis with multiple additional schwannomas, meningioma, as well as intramedullary lesions which may represent ependymomas, not appreciably changed since 3/30/2016. Please see additional details above.