Postop 3-month tumor follow-up of cervical tumor. Compared to prior MRI from 9/9/2014, there is been interval evolution of postoperative changes of C3 to C5 laminectomy and resection of neurofibromas at the bilateral C4-C5 and C5-C6 levels. Again seen is posterior spinal fusion hardware at the C3 to C5 levels with susceptibility artifact slightly limiting evaluation Again seen is deformity involving the cervical cord from the C3 to the C5-C6 levels with areas of cystic change particularly at the C3 and C5-C6 levels. Previously seen expansile T2 hyperintensity at the C3 and C4 levels has markedly decreased with decrease in edema and development of volume loss at this level consistent with myelomalacia. There is some irregularity in the contour of the cord at this level which may also be related to adhesions. Extensive paraspinal neurofibromas are evident throughout the cervical spine, entering and expanding the neural foramina with individual levels as below:C2/3: Neurofibromas are confined to the extradural space, presumably postoperative. The postoperative canal at this level is patulous.C3/4: Neurofibromas are confined to the extradural space, presumably postoperative. The postoperative canal at this level is patulous. Cystic encephalomalacia and adhesions noted.C4/5: Previously seen neurofibromas involving the lateral epidural space and compressing the cord have been resected. Spinal canal is patent. Cord is deformed.C5/6: Previously seen neurofibromas involving the lateral epidural space and compressing the cord have been resected. Spinal canal is patent. Cord is deformed.C6/7: Bilateral dumbbell neurofibromas extend into the lateral epidural space posteriorly and mildly compress the cord, left relatively greater than right are unchanged since 8/28/2014.C7/T1: Bilateral dumbbell neurofibromas extend into the lateral epidural space mildly compress the cord, left significantly greater than right. No significant change is 8/28/2014.Multiple muscular and cutaneous neurofibromas are also again noted.
1.Compared to immediate postoperative study from 9/9/2014 and earlier study from 8/28/2014, there is evolution of recent postsurgical changes related to resection of neurofibromas at the C4-C5 and C5-C6 levels which were previously seen extending into the lateral epidural space and compressing the cord.2. There is decrease in previously seen edema at the C3 and C4 levels and progression of myelomalacia extending to the C5-C6 level inferiorly. Irregularity involving the cord contour likely related to combination of myelomalacia and adhesions in the thecal sac.3. Neurofibromas involving the C6-C7 and C7-T1 levels with mild epidural extension and mild mass effect on the cord are not significantly changed since 8/28/2014.