Reason: s/p Cervical lami for tumor/ Schwannoma. f/u 2 months postop for change. Surveillance. There are postsurgical changes of laminectomy at the left C4-C5 level. There has been near total resection of the intradural extramedullary tumor at the C4-C5 level which is contiguous with the left C4-C5 foraminal tumor and likely representing a schwannoma. There is minimal residual enhancement measuring approximately 5 x 4 mm on the left ventral surface of the cord. The spinal canal however is well decompressed and previously seen compressed cervical cord is now well expanded. There is T2 hyperintensity involving the cervical cord at the C4-C5 level particularly in its central aspect with evidence of mild volume loss, at least much of the signal abnormality which is reflective of myelomalacia from prior chronic compression.The foraminal and extraforaminal portion of the tumor at the left C4-C5 level is similar to prior and again noted to displace and partially compress the left vertebral artery. This tumor measures up to 14 mm in the short axis, similar to prior.Posterior small dural based lesions at the C1-C2 level measuring approximately 7 x 10 mm and at the inferior C2 level measuring approximately 3 x 6 mm again seen and likely representing small meningiomas. These lesions contact the posterior lateral aspect of the cervical cord with minimal local mass effect. 2 mm intradural extramedullary lesion in the left dorsal aspect of the spinal canal at the C5 level is also again seen. Small right C5-C6 neural foraminal lesion is also again seen without intraspinal extension.Vertebral body heights are maintained. Diffuse low T1 marrow signal is again evident and nonspecific. Mild anterolisthesis at C4 and C5 and kyphotic angulation centered at the C5 level is grossly similar to prior. Partially imaged brain again demonstrates volume loss involving the right lateral aspect of the cerebellum and a T2 hyperintense lesion in the left parotid gland, better assessed previously.
1. Expected interval postsurgical changes of resection of intradural extramedullary mass at the C4-C5 level with near total resection of the intraspinal component of the tumor. There is resolution of the previously seen compression of the cord. There is T2 cord signal abnormality at this level, at least most of which represents myelomalacia related to prior compression from the tumor.2. Additional stigmata of NF 2 including residual foraminal/extraforaminal tumor at the left C4-C5 level and a small right C5-C6 foraminal lesion are consistent with schwannomas and similar to prior. Additional small probable meningiomas at the C1 and C2 level involving the posterior aspects of the spinal canal are also similar to prior with minimal local mass effect on the dorsolateral aspect of the cord.