 Compared to 12/10/2015, interval evolution of postoperative changes at the C1 and C2 levels related to tumor resection are seen. Postoperative epidural blood products and fluid collection have resolved with reexpansion of the thecal sac. Minimal residual intradural enhancement is seen without mass effect. Residual extradural tumor remains at these levels similar to prior without mass effect on the thecal sac. Increased enhancement is noted in the midline paraspinous soft tissues consistent with postoperative change.Enhancing mildly expansile masses are seen at all levels in the cervical neural foramina which are not significantly changed since prior and without significant intraspinal extension. The previously noted enhancing oval mass in the left posterior paraspinal soft tissues at C2 measures 30 x 18 mm x 30 which is not significantly changed for differences in measurement technique although gradually enlarged since study from 8/8/2013 when this mass measured approximately 19 x 14 x 24 mm.Enhancing mass involving the left upper thoracic neural foramen extending into the lung apex is partially imaged. No expansile intramedullary lesions are seen. There is T2 hyperintensity with significant volume loss involving the cervical cord at the C2 level consistent with myelomalacia. Kyphosis of the cervical spine with apex at C4 is again seen, not significantly changed. Vertebral body heights are maintained. No concerning marrow replacement is seen. Multiple prior cervical laminectomies are noted extending inferiorly to the C5 level. There is no significant spinal canal stenosis at any level.
1. Compared to 12/10/2015, there has been evolution of postsurgical changes related to intradural and extradural tumor resection at C1 and C2. There has been resolution of the previously seen postoperative fluid and blood products which were previously effacing the thecal sac. There is no residual mass effect on the thecal sac. Noted is T2 hyperintensity and moderate focal volume loss involving the cervical cord at the C1-C2 level compatible with myelomalacia and presumably related to previous chronic compression. 2. Multiple additional neurofibromas involving the cervical spine and paraspinous soft tissues demonstrate no significant interval change. No findings to suggest intramedullary neoplasm.3. Left posterior paraspinous soft tissues lesion at the C2 level demonstrates enlargement compared to 2013.