Status post meningioma resection in 2012, surveillance imaging. Shoulder pain. Brain: Absence of contrast slightly limits evaluation. Again seen are postsurgical changes of right frontoparietal craniotomy for meningioma resection with encephalomalacia involving the right paracentral lobule appearing unchanged since 9/30/2014. No discrete mass to suggest tumor recurrence is appreciated. Scattered T2/FLAIR hyperintensity in the deep, subcortical, and periventricular white matter are nonspecific but likely represent chronic small vessel ischemic changes and similar to prior. No intracranial mass effect, midline shift or herniation. No hydrocephalus.Mild cerebellar tonsillar ectopia and foramen magnum crowding remains unchanged. Left phthisis bulbi is noted. Right globe prosthesis again seen. Paranasal sinuses and mastoid air cells are clear. Cervical spine: Again seen are postsurgical changes of prior anterior cervical discectomy and fusion at the C5-C6 levels. Hardware is better assessed on prior radiograph including lucency surrounding the C5 screw. There is partial fusion involving the C4-C6 vertebral bodies. Again seen is a tiny syrinx extending from the T1-T2 level in the left aspect of the cord. Again seen is straightening of the normal cervical lordosis and multilevel degenerative changes, individual levels as below:C2-3: Small central disc protrusion. No significant compromise to the spinal canal or neural foramina.C3-4: Small central disc protrusion. No significant compromise to the spinal canal or neural foramina.C4-5: Left paracentral disc osteophyte complex resulting in flattening of the ventral cord on the left. Dorsal thecal sac is patent. No cord signal abnormality. No significant neural foraminal stenosis.C5-6: Small osteophyte. Minimal spinal canal narrowing. No significant neural foraminal stenosis.C6-7: There is a disc bulge and ligamentum flavum thickening resulting in mild to moderate spinal canal stenosis. No significant neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.
1. Postsurgical changes of prior right posterior frontal convexity meningioma resection. No evidence of tumor recurrence within the limitations of noncontrast study.2. There are multilevel degenerative changes in the cervical spine including prominent left paracentral disc osteophyte complex at the C4-C5 level which mildly impresses on the left ventral aspect of the cord, similar to 7/10/2012. Dorsal thecal sac is patent at this level. No associated cord signal abnormality. There is also mild to moderate spinal canal stenosis at the C6-C7 level which is minimally worse since 7/10/2012. No significant neural foraminal stenosis at any level in the cervical spine. 3. Anterior cervical fusion hardware better assessed on recent radiograph.4. Tiny syrinx at the T1-T2 level just to the left of the midline remains unchanged since 7/10/2012.