 Brain: Again seen are postoperative changes of suboccipital decompressive craniectomy and C1 laminectomy related to resection of small meningioma at the C1-C2 level. Again seen is a fluid collection in the suboccipital craniectomy surgical bed which is slightly smaller in the interval and likely represents a pseudomeningocele. The heterogeneously enhancing mass with cystic changes involving the medulla and upper cervical cord appears similar in size and configuration, measuring 2.4 x 3.5 cm in the AP and craniocaudal dimensions. There is clear enlargement of this mass compared to more remote MRI spine from 6/18/2012 when it measured 1.5 x 2.5 cm in the sagittal dimension. The other known intracranial masses also are not significantly changed including a left cavernous sinus mass which extends superiorly into the lateral aspect of the suprasellar cistern and posteriorly into the Meckel's cave; mass is compatible with a meningioma or schwannoma. Bilateral vestibular schwannomas involving the internal auditory canals are unchanged measuring approximately 9 mm bilaterally. Enhancing extra-axial lesion measuring approximately 7 mm in the right suprasellar cistern abutting the right optic nerve is also unchanged. Small areas of extra-axial enhancement along the falx are also unchanged and likely related to tiny meningiomas.Evaluation of the orbits on the brain sequences again demonstrates an enhancing mass in the left orbit extending from the orbital apex to just posterior to the globe likely representing an optic nerve sheath meningioma. No significant change in diffuse thickening, T2 hyperintensity and enhancement involving the left upper eyelid as well as the left temporalis muscle.No evidence of acute ischemia or hemorrhage. No new mass effect. No hydrocephalus. There is a small left maxillary sinus mucosal retention cyst. Fatty denervation changes are noted involving the right hemitongue and present previously since at least 4/1/2015.Cervical Spine: Minimal dural based enhancement is seen along the dorsal C1-C2 level without evidence of recurrence of previously resected meningioma at this level. Cervicomedullary enhancing mass as described above is not significantly changed since 2/23/2015 and likely represents an ependymoma. Smaller intramedullary cord masses at the C3 and the T3 level also appear similar. More punctate intramedullary enhancing foci at the C4 and C6 levels are also unchanged since 2/23/2015. Compared to 6/18/2012, there is clear enlargement of the cervical medullary junction mass as mentioned above and also of the T3 lesion which measures approximately 8 mm in the craniocaudal dimension.Extra-axial enhancing lesion consistent with meningioma at the at the T1-T2 level which mildly impresses the dorsal aspect of the upper thoracic cord also is not significantly changed. Otherwise no significant spinal canal or neural foraminal stenosis is appreciated.Vertebral body heights in the cervical and upper thoracic spine are normal. Alignment is maintained aside from loss of cervical lordosis. No significant disc disease.
1. Continued evolution of postsurgical changes of suboccipital decompression and resection of small C1-C2 meningioma. There is minimal dural based enhancement without evidence of meningioma recurrence at this location. Mild decrease in size of fluid collection in the surgical bed is seen, which likely represents a pseudomeningocele. 2. No significant change in left orbital mass which likely represents an optic nerve sheath meningioma when compared to most recent study. There is mild enlargement when compared to more remote studies dating back to 6/15/2012 with mild compression of the left optic nerve. 3. Additional stigmata of neurofibromatosis type 2 with additional masses including a left cavernous sinus meningioma, small falcine meningiomas, and bilateral vestibular schwannomas which are not significantly changed. Multiple enhancing masses in the cervical and visualized thoracic cord are not significant changed since 2/23/2015 cervical spine MRI. Compared to 6/18/2012, however, there is enlargement of the large cervicomedullary and smaller T3 intramedullary enhancing masses which likely represent ependymomas.4. Mild impression on the right dorsal aspect of the thoracic cord at the T1-T2 level related to meningioma, minimally worse since 6/18/2012. Otherwise no significant spinal canal or neural foraminal stenosis is appreciated in the cervical or imaged upper thoracic spine.