33 yo F with VHL with known h/o cervical spine hemangioblastoma s/p removal here; assess for new lesions. Brain: Again seen is a punctate focus of enhancement along the right posterior aspect of the medulla measuring 2 mm. There is also a subtle 2 mm focus of enhancement involving the left anterolateral lateral aspect of the medulla (high resolution axial postgadolinium 3D series series 7 image 55). Brain parenchyma appears otherwise unremarkable. No new intracranial mass or mass effect. Ventricles and sulci are within normal limits. Unchanged small pineal gland cyst without mass effect. Calvarium and extracranial soft tissues are unremarkable. No temporal bone masses are evident to suggest endolymphatic sac tumor. Spine: Again seen are postsurgical changes C6 and C7 laminectomy for resection of previous seen dorsal cervical cord hemangioblastoma at the C6-C7 level. No residual or recurrent enhancement or mass is appreciated involving the cervical cord. There is no abnormal enhancement or mass in the cervical, thoracic, or lumbar spinal canal to suggest hemangioblastoma. The vertebral column alignment is unchanged. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is a small left paracentral disc extrusion at the C5-C6 level which appears minimally larger than prior and is not associated with significant spinal canal or neural foraminal stenosis. No significant spinal canal or neural foraminal stenosis in the cervical, thoracic, or lumbar spine.
1. Subtle 2 mm foci of enhancement seen only on the high-resolution post gadolinium sequence involving the right posterior and left anterolateral surfaces of the medulla may possibly represent tiny hemangioblastomas, but given the small size of these foci of enhancement, normal vascular structures also remains a possibility. No findings to definitively suggest a new or enlarging lesion. Brain parenchyma is otherwise unremarkable. No temporal bone masses to suggest endolymphatic sac tumor.2. Postoperative changes related to prior resection of dorsal cervical cord hemangioblastoma at the C6-C7 level. There is no evidence of residual or recurrent tumor in the cervical, thoracic, or lumbar spine.3. Small left C5-C6 disc extrusion without significant spinal canal or neural foraminal stenosis.