 Prominent susceptibility is again identified along the left greater than right posterior scalp, with limited evaluation of surrounding structures, likely relating to postoperative changes. In addition, there are a few foci of susceptibility in the posterior fossa, with a prominent area along the left brachium pontis, presumably relating to previous vestibular schwannoma resections. There are also scattered areas of T2/FLAIR hyperintensity along the right cerebellar hemisphere and right greater than left brachium pontis with volume loss on the left, also presumably postoperative. There is mild diffuse dural thickening and enhancement appears similar.Additional punctate susceptibility is present along the posterior right frontal lobe. A prominent heterogeneous area of susceptibility persists in the right frontal lobe corresponding to a known meningioma which is presumably partially calcified. This dural based enhancing extra-axial mass is unchanged in size measuring 3.0 cm transverse x 3.1 cm CC x 2.9 cm AP. An adjacent smaller left paramedian enhancing extra-axial oval mass off the anterior aspect of the falx again measures 1.7 x 1.2 cm in greatest axial dimensions. Multiple other scattered plaque-like extra-axial dural based masses along the cerebral convexity and falx, some of which are located along the margins of the superior sagittal sinus appear stable. Grossly, the superior sagittal sinus remains patent, although there are areas of mass effect or centrally located parasagittal masses. A few smaller presumed meningiomas are seen along the inferior and lateral frontal lobes as well as the anterior right temporal lobe, which are also unchanged.There is a lobulated homogeneous enhancing mass at the right cerebellopontine angle, presumably a vestibular schwannoma, measuring 2.4 x 3.1 cm in greatest axial dimensions, unchanged. There is also abnormal extra-axial enhancement along the left cerebellopontine angle extending into the region of the left internal auditory canal which could be better assessed with a dedicated IAC MRI.A right Meckel's cave/cavernous sinus mass with central heterogeneity measures 1.9 x 2.2 cm, unchanged. Enhancing tissue is also seen in left Meckel's cave, grossly similar, likely an additional trigeminal schwannoma. Asymmetric T1 and T2 hyperintense fat signal is identified right masticator space and right sphenoid region which may relate to prior radiation treatment.There is a stable oval enhancing mass along the right retropharyngeal space, partially visualized but grossly similar, measuring up to 1.7 x 2.7 cm. As before, smaller enhancing masses are seen in the left lateral parapharyngeal space as well as within the deep left parotid gland. A smaller enhancing nodule is seen ventral to the left midbrain with adjacent nerve thickening extending into the left cavernous sinus, which appears to represent the cisternal left oculomotor nerve, unchanged in appearance.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift. There are no areas of pathological parenchymal enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. As before, there is fluid opacification in the left mastoid region.SPINE
1.Stable multiple intracranial masses, representing multiple meningiomas and cranial nerve schwannomas as detailed above.2.No significant interval change in foramen magnum level partially exophytic mass at the level of the cervicomedullary junction, which may relate to an ependymoma, less likely a meningioma or nerve sheath tumor at this level.3.Extensive intramedullary neoplastic disease throughout the entire cord as well as intradural extra medullary lesions. No significant interval change with essentially complete effacement of CSF space along the expanded cervical cord and upper thoracic levels.4.Postoperative changes along the upper lumbar spine with no definite masslike recurrence of enhancement at the level of previous conus ependymoma, although significant intrathecal burden of masses remaining at other levels, stable in appearance.5.Other partially visualized masses such as in the right suprarenal location, right retropharyngeal space, posterior to the right thyroid gland, and along the lower neck paraspinal musculature are grossly stable.