Male, 14 years old, with neurofibromatosis type II, presenting with unsteadiness, right leg pain, and coordination problems. Brain and IACs:Solid enhancing tumors within both internal auditory canals are redemonstrated. Both lesions demonstrate a mild interval increase in size. For reference purposes, the lesion on the right measures approximately 10 x 6 mm, and previously measured approximately 6 x 4 mm.Thickening and abnormal enhancement of the cisternal segments of the bilateral fifth cranial nerves is also seen, right side more than left. These lesions have also become more conspicuous when compared to the prior examination. On the right this abnormal thickening and enhancement involves the cavernous sinuses as well.Patchy T2 hyperintensity and dysmorphism within the right lateral cerebral hemisphere is again seen without significant interval change. Smaller areas of signal abnormality are also unchanged within the left cerebellar in the superior. The cerebellar lesions are associated with foci of susceptibility which could reflect either mineralization, vascular structures or chronic hemosiderin deposition.A small focus of abnormal T2 hyperintensity and mild dysmorphism is seen within the left superior temporal gyrus. This region also shows minimal susceptibility effect and there is a small amount of ill-defined enhancement as well.No evidence of significant generalized mass effect is seen. No abnormal extra-axial fluid collections are detected. The ventricular system remains normal in size and morphology.A plaque-like enhancing lesion is evident along the left intraorbital optic nerve. This lesion was present on the prior examination and does not appear to have changed substantially.Spine:A large intradural extramedullary tumor is evident at the T4 level measuring up to 30 mm CC and 15 x 12 mm transaxial. The lesion enhances homogeneously and is relatively T2 hypointense. This lesion occupies nearly the entire spinal canal causing severe canal stenosis and severe cord compression. The cord is markedly flattened and displaced to the left anterior aspect of the spinal canal.At the C4 level, there is an enhancing intradural extramedullary tumor within the left lateral aspect of the spinal canal measuring up to 9 x 7 mm transaxial. This lesion exerts mild mass effect upon the spinal cord but without obvious cord edema.Numerous scattered small nodules ranging in size from punctate to 5 mm are seen along the conus and nerve roots of the cauda equina.Multiple foci of abnormal spinal cord signal, thickening and pathologic enhancement are seen including at the C2 and C3 levels and at the T2 and T3 levels.A few scattered areas of questionable foraminal and extraforaminal nerve root thickening are seen though none of these is large or discrete enough to allow for confident diagnosis of tumor.Allowing for a mild scoliotic curvature of the thoracic spine, alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow signal abnormality is detected.
1.A large intradural extramedullary tumor is evident at the T4 level occupying nearly the entire spinal canal and causing a severe canal stenosis and severe cord compression. The signal characteristics of this lesion favor meningioma over nerve sheath tumor.2.A smaller intradural extra medullary tumor is evident within the left lateral aspect of the spinal canal at C4. This lesion causes only mild mass effect upon the spinal cord. The differential would include both nerve sheath tumor and meningioma.3.Numerous small enhancing nodules are seen along the conus and nerve roots of the cauda equina, likely representing small nerve sheath tumors.4.Multiple areas of abnormal cord thickening and enhancement are seen in the cervical and upper thoracic regions. These lesions are compatible with primary spinal cord neoplasms and statistically are most likely to represent ependymomas.5.Bilateral internal auditory canal nerve sheath tumors have mildly increased in size when compared to the prior examination.6.Nerve sheath tumors involving the bilateral fifth cranial nerves have also increased in size. Thickening and abnormal enhancement centered on the right cavernous sinus has also increased and may represent continuation of the nerve sheath tumor or meningioma.7.Scattered areas of parenchymal signal abnormality with mild dysmorphism of the overlying cortex and evidence of susceptibility are seen in both cerebellar hemispheres and in the left superior temporal gyrus. These lesions have not significantly changed from the prior examination and could represent areas of hamartomatous or dysplastic tissue. Low grade neoplasm is considered less likely.8.A small plaque-like enhancing lesion is evident along the intraorbital component of the left optic nerve. This lesion has not significantly changed and the differential would include meningioma versus nerve sheath tumor.