Neurofibromatosis type II. New daily persistent headache. The study is mildly to moderately limited by patient motion.BRAIN:There are postoperative findings related to right frontal meningioma resection. In addition, there has been chronic evolution of the associated right frontal infarct, developing into encephalomalacia and associated ex vacuo enlargement of the frontal horn of the right lateral ventricle. An irregular band of contrast enhancement along the surgical margin, superficial to the infarct and deep to the craniotomy flap, is slightly more pronounced. There is minimal dural thickening underlying the craniotomy flap with trace residual extra-axial fluid. The soft tissue nodule in the left lateral ventricular atrium is unchanged, measures up to 15 mm, and may represent a small meningioma. The left frontal lobe parafalcine meningioma with suggestion of involvement of the anterior part of the superior sagittal sinus is unchanged as well as the associated involvement of the inner table of the skull. The dural sinuses are otherwise patent. The smaller meningioma involving the right greater wing of the sphenoid is unchanged.The contrast-enhancing mass along the cisternal segment of the left trigeminal nerve is unchanged, compatible with a schwannoma. Also, the contrast-enhancing masses involving the internal auditory canals/cerebellopontine angle cisterns are not significantly changed with the larger right one measuring up to 2.6 cm x 1.5 cm compared to 2.5 cm x 1.5 cm previously. The tiny contrast-enhancing nodule along the left cerebellomedullary junction is unchanged.The subcortical T2-hyperintensity in the medial aspect of the right frontal lobe is unchanged. In addition to the above-described ex vacuo enlargement of the frontal horn of the right lateral ventricle, the ventricular system is slightly larger than on the prior examination but there is no transependymal edema.There are findings related to previous posterior fossa surgeries. The right maxillary sinus is significantly smaller which might reflect prior chronic sinusitis or trauma. The orbits are grossly unremarkable.CERVICAL SPINE:The central, contrast-enhancing spinal cord lesion at C1-C2 level which measures up to 8 mm is unchanged. Also, the associated surrounding T2-hyperintensity and cord expansion are is unchanged. The cervical spinal alignment is preserved. There is no significant spinal canal stenosis. There are shallow ventral indentations of the thecal sac by the disc-osteophyte complexes, which is unchanged. There are numerous small soft tissue nodules on both sides of the neck, which follow the expected distribution of lymph nodes. THORACIC SPINE:There is incomplete fusion with minimal associated kyphosis between T10 and T11 vertebral bodies. The respective facets are poorly developed. The spinal cord assumes mild but sharp angulation at this level which is associated with mild expansion of the central canal. These findings are unchanged since the previous examination. There is no abnormal spinal cord signal, otherwise. The spinal canal is also otherwise preserved. The vertebral bodies are preserved in height and there is no suspicious marrow signal abnormality. Multiple contrast-enhancing nodules are present along the surface of the caudal thoracic spinal cord and along the cauda equina roots, as described below.LUMBAR SPINE:Of note, there is a variant segmentation with partial sacralization of L5. Numerous intradural, extramedullary contrast-enhancing nodules on the surface of the caudal spinal cord and along the cauda equina roots are grossly unchanged since the previous examination. The largest measures up to 7 mm and is present on the left side of the conus at T11-T12 level.The vertebral bodies are preserved in alignment and morphology and there is no suspicious marrow lesion. The spinal canal is also preserved. There is mild degenerative disc bulge at L4-L5 associated with mild biforaminal stenosis.Small mildly T1-hyperintense, T2-hyperintense lesion in the right kidney is unchanged since the previous examination.Focal expansion of the right S1 nerve root with associated expansion of the sacral foramina remain unchanged.
1.Expected evolution of the now chronic right frontal encephalomalacia and other postoperative changes.2.The contrast enhancement along the right frontal resection margin, superficial to the infarct and deep to the craniotomy flap, is more pronounced compared to the previous examination. Continued follow-up is recommended.3.Other stigmata of neurofibromatosis type II including meningiomas and schwannomas remain unchanged.4.Intramedullary upper cervical spinal lesion is unchanged and may represent ependymoma. 5.Multiple grossly stable contrast-enhancing intradural, extramedullary lesions along the surface of the distal spinal cord and cauda equina are also not grossly changed since the previous examination.6.Small right kidney lesion with atypical signal characteristics can be better assessed by ultrasound but could represent a proteinaceous/hemorrhagic cyst.