Neurofibromatosis type I. Evaluate extent of the plexiform tumor, any cord compression? There are postsurgical changes of anterior and posterior spinal fusion in the cervical spine. Anterior and posterior hardware can be better assessed with radiographs or CT. There is dural ectasia with extensive scalloping involving the cervical vertebrae resulting in severe thinning of the cervical vertebral bodies. Susceptibility artifact related to the hardware limits assessment of the residual vertebra ventrally.There is widening of the atlantodental interval measuring approximately 9 mm. There is approximately 90 degree angulation at the craniocervical junction with resultant effacement of the ventral thecal sac and mild impression on the ventral cervicomedullary junction. No associated parenchymal signal abnormality. There is no stenosis in the cervical spinal canal at any level.There are multiple masses involving the neck and paraspinous soft tissues, particularly on the left. There is a large left retropharyngeal mass measuring 3.9 x 5.6 x 8.8 cm, in the AP, transverse, and craniocaudal dimensions. There is significant associated deformity on the left lateral pharyngeal wall with rightward displacement and narrowing of the oropharyngeal lumen. There is also lateral displacement of the left carotid vasculature. There is a relatively smaller mass involving the left prevertebral space coursing along the margins of the left cervical vertebrae and anterior fusion hardware. This mass is questionably contiguous with the soft tissue filling the atlantodental interval which is widened as mentioned above. There is a relatively large mass involving the left lateral cervical paraspinous soft tissues measuring approximately 4.4 x 5.5 cm in the axial plane and extends craniocaudally from the C2 level to the approximately T3 level. There is no intraspinal extension associated with these lesions.Extensive masses compatible with neurofibromas are noted in the region left brachial plexus including the left supraclavicular fossa. Neurofibromas involving the upper thoracic nerve roots are also noted, with associated mass at the left thoracic inlet/lung apex measuring 1.8 x 3.1 x 4.4 cm. Multiple additional lesions including along the intercostal nerves, mediastinum, and subcutaneous soft tissues are also noted.
1. Stigmata of neurofibromatosis type I with multiple large heterogeneously enhancing neurofibromas in the left retropharyngeal, prevertebral, as well as cervical paraspinous soft tissues as described above. Extensive involvement in the left neck in the region of the left brachial plexus is also seen. There is no extension into the spinal canal associated with these lesions.2. Dural ectasia with resultant severe scalloping of the cervical vertebrae. Radiographs or CT can better assess the anterior and posterior fusion hardware and amount of residual bone in the cervical spine.3. There is no significant spinal canal stenosis. There is however abnormal configuration of the craniocervical junction with approximately 90 degree angulation and resultant mild ventral impingement at the cervicomedullary junction. There is also widening of the atlantodental interval measuring approximately 9 mm, possibly related to an underlying neurofibroma. Transverse ligament is intact. Please see details above.