Left lower extremity weakness. Evaluate for acute injury to cervical spine following laminectomy and C5 tumor resection. History of NF 2. There are interval 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 again seen. There is T2 hyperintensity involving the right aspect of the cervical cord which has increased/become more apparent since prior study from 3/8/2016. There is an extra-axial collection in the dorsal epidural space extending from the C5-C7 levels which completely effaces the dorsal thecal sac and is associated with increased flattening of the cervical cord compared to prior. There is also associated T2 hyperintensity in the cervical cord extending from the C5-C6 to C6-C7 levels bilaterally, left greater than right, which is increased since prior.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 noted which may represent a meningioma.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. Enhancing mass is present at the right C1-C2 level with intraspinal extension and effacement of the right lateral thecal sac which is stable to minimally more prominent than before.. Two small enhancing intramedullary lesions are seen within the cord at the C1-C2 and mid C2 levels suspicious for tumor as before. Additional tiny nodules of enhancement are also seen inferior medulla and possibly in the mid and lower cervical cord. Individual levels as below:C2-C3: Enhancing left nerve root with mild expansion of the neural foramen. There is an extramedullary lesion involving the left anterolateral aspect of the spinal canal without significant mass effect on the cord as before and possibly contiguous with the 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 remains leftward displacement of the cord as well as local mass effect on the right lateral aspect of the cord, but improved since prior.C5-C6: Large, predominantly extraforaminal lesion on the right unchanged. Small enhancing extra foraminal lesion on the left is likely unchanged. No spinal canal stenosis.C6-C7: Small,predominantly extraforaminal enhancing lesions bilaterally without expansion of the foramina are likely unchanged. No spinal canal stenosis.C7-T1: Small predominantly extraforaminal enhancing lesions without expansion of the foramina, likely unchanged. No spinal canal stenosis.Additional smaller schwannomas partially visualized within the thoracic spine.
1. Interval 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 again seen. 2. There is T2 hyperintensity involving the right aspect of the cervical cord at the C4-C5 level which has increased/become more apparent since prior study from 3/8/2016. 3. There is a fluid collection in the dorsal epidural space extending from the C5 to C7 levels which is associated with worsened effacement of the dorsal thecal sac and increased flattening of the cervical cord compared to prior. There is also associated T2 hyperintensity in the cervical cord extending from the C5-C6 to C6-C7 levels bilaterally, left greater than right, which is increased since prior.4. Stigmata of neurofibromatosis with multiple additional schwannomas, meningioma, as well as intramedullary lesions which may represent representing ependymoma similar to prior.