 Again seen are multiple neurofibromas involving the neural foramina throughout the cervical spinal canal bilaterally. There is severe cervical spinal canal stenosis related to the bilateral nerve sheath tumors at the C1-C2 level with severe compressive deformity of the cord due to epidural tumor bilaterally similar to prior. Lesions measure approximately 19 mm in the AP dimension, similar to prior. Focus of cystic change within the tumor on the left is minimally larger than prior. No evidence of significant spinal canal stenosis or significant epidural extension at any level aside from the C1-C2 level mentioned above.Again seen is reversal of cervical lordosis with kyphotic attenuation with apex at the C4-C5 level, similar to prior. There is angulation of the cervical cord related to the kyphosis. No cord signal abnormality is definitively appreciated. There is enlargement of a lesion involving the left posterior paraspinous soft tissues at the C2 level which measures 18 x 26 x 30 mm previously 14 x 20 x 20 mm. Numerous additional lesions involving the cutaneous, subcutaneous, and paraspinous soft tissues are also similar to prior. Mastoid air cell opacification again noted on the right.THORACIC SPINE
1. There is interval enlargement of left posterior paraspinous soft tissues lesion at the C2 level which measures 18 x 26 x 30 mm previously 14 x 20 x 20 mm.2. No significant change in the multiple neurofibromas involving the neural foramina relatively largest of which is seen at the C1-C2 level and extends into the epidural space, resulting in severe compressive deformity of the upper cervical cord at this level. This appearance however is not significantly changed compared to MRI from 8/8/2013. 3. No significant change in multiple thoracic neurofibromas relatively largest of which is seen in the left upper thoracic paraspinous region extending into the left thoracic apex. Left T10-T11 lesion which extends into the epidural space and causes mild mass effect on the thoracic cord is also not significantly changed. 4. In the lumbar spine, multiple neurofibromas are mostly not significantly changed, the relatively largest of which is along the left L4 nerve root and not significantly changed. There is enlargement of a 10 mm lesion in the spinal canal at the L5 level, previously 8 mm on prior lumbar spine MRI study from 2007.5. Splenomegaly and elevation of the left hemidiaphragm noted.