Female, 53 years old, with von Hippel-Lindau disease and multiple hemangioblastomas. Brain:Findings are redemonstrated compatible with prior left suboccipital craniotomy and mastoid approach surgery. A resection cavity is demonstrated involving the right aspect of the vermis and medial cerebellar hemisphere. Bands of T2 hyperintensity traversing both the cerebellar hemispheres have not significantly changed. Also unchanged is mild T2 hyperintensity within the right cerebellar tonsil, along the surgical cavity margins, and within the left aspect of the cervico-medullary junction. A few punctate foci of susceptibility along the margins of the resection cavity are unchanged. No new abnormality is detected within the posterior fossa. Allowing for surgical alteration of the left mastoid region, no evidence of recurrent inner ear tumor is seen.Supratentorially, there are scattered small foci of white matter T2 hyperintensity which have not significantly changed and are non-specific. No evidence of parenchymal edema or mass effect is seen. No intracranial hemorrhage or abnormal extra axial fluid is detected. The ventricles are stable and normal in size.A left globe prosthesis is in place. Findings in the right globe are seen suggesting choroidal detachment, similar to prior.Cervical spine:There is evidence of posterior element resection at most levels of the cervical spine, unchanged.As above, T2 hyperintensity persists on the left at the level of the cervico-medullary junction without significant interval change. No new areas of cord signal abnormality are seen, though assessment of the cervical cord is somewhat limited by motion artifact.The cervical lordosis is mildly straightened. Vertebral body heights are preserved. No concerning signal abnormality is detected.Posterior disk osteophyte formation is seen at most levels of the cervical spine with significant loss of disk height at C5-6 and C6-7. Level specific findings are as follows:C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild posterior disk osteophyte. No significant spinal canal stenosis or neuroforaminal narrowing.C4-5: Mild posterior disk osteophyte. No significant spinal canal stenosis or neuroforaminal narrowing.C5-6: Posterior disk osteophyte formation along with ligamentum flavum thickening results in a moderate spinal canal stenosis and mild cord deformation. Severe left and moderate right foraminal narrowing. No significant interval changes. C6-7: Left facet hypertrophy. Mild posterior disk osteophyte. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Thoracic spine:The thoracic kyphosis is mildly exaggerated at T12 secondary to mild vertebral body wedging without change. No evidence of any worrisome marrow replacement or marrow edema is seen.No definite evidence of any spinal cord signal abnormality is seen. Morphology of the cord is within normal limits. Although again, assessment of the cord is compromised by motion artifact.A small central disk protrusion is present at T8-9 along with a left paracentral protrusion at T11-12. No significant spinal canal or neuroforaminal stenosis is detected.Innumerable bilateral renal cystic lesions are identified, some of which contain heterogeneous material and/or fluid-fluid levels. Findings are grossly similar to those seen on the prior examination, though this examination is not adequate for assessment of individual lesions.Lumbar spine:Alignment is anatomic. Vertebral body heights are preserved. No concerning marrow replacement or edema is seen.The visualized spinal cord, conus and cauda equina are within normal limits. No definite spinal masses are detected. L1-2: Mild bulging disk with a right paracentral protrusion. No significant generalized spinal canal stenosis. No foraminal narrowing. No interval changes. L2-3: Mild bulging disk. No significant spinal canal stenosis or neuroforaminal narrowing.L3-4: Mild bulging disk. No significant spinal canal or neuroforaminal stenosis. L4-5: No spinal canal stenosis or neuroforaminal narrowing. L5-S1: Bulging disk and central disk protrusion with slight decrease in the size of the protrusion. No significant generalized spinal canal stenosis. No significant foraminal narrowing.
1.Evidence of prior surgery is again seen involving the left mastoid bone and the posterior fossa. Areas of signal abnormality involving the cerebellum and cervicomedullary junction are unchanged. No new mass lesion is appreciated within the limits of a noncontrast examination.2.Postoperative findings are again seen in the cervical C-spine. No areas of significant new spinal cord signal abnormality are noted, given the slightly motion degraded exam. No definite new spinal cord or intracanalicular lesions are seen within the limits of a noncontrast examination.