15-year-old male with neurofibromas type II, vestibular and cervical spine schwannomas, postoperative right schwannoma removal. Brain and Internal Auditory Canals:There are changes from interval right sided IAC schwannoma removal including craniotomy, soft tissue swelling with fluid and enhancement, as well as a complex signal collection adjacent to the right cerebellar hemisphere causing mild right cerebellar hemispheric flattening, however without parenchymal signal abnormality. There is also diffuse, smooth, dural enhancement, most consistent with prior surgery.There is a small area of enhancement involving the right internal auditory canal, with a complex morphology, appearing somewhat curvilinear around its circumference at the porus acusticus, with a small nodular component anteriorly at the porous acusticus. It is uncertain if this represents postoperative granulation tissue versus residual schwannoma.There has been no interval change in size of an enhancing mass in the left internal auditory canal, with slight extension medially through the porus acusticus, again measuring 6 x 9 mm in axial cross-section.There are unchanged enlarged perivascular spaces in the left middle frontal gyrus with confluent surrounding T2 hyperintensity. There is a similar finding to a lesser extent in the right middle frontal gyrus. There are unchanged mildly low-lying cerebellar tonsils. The orbits, skull, and scalp soft tissues are unremarkable. There is no evidence of acute intracranial hemorrhage or infarction. There is no midline shift. Cervical Spine: There is stable right anterolateral intradural, extramedullary, tubular, enhancing lesion at the C6-7 level that measures 6 x 2 mm in axial cross-section. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.
1.There are changes from interval right sided IAC schwannoma removal. There is a small area of enhancement involving the right internal auditory canal, with a complex morphology, appearing somewhat curvilinear around its circumference at the porus acusticus, with a small nodular component anteriorly at the porous acusticus. It is uncertain if this represents postoperative granulation tissue versus residual schwannoma.2.There has been no interval change in size of an enhancing mass in the left internal auditory canal3.Unchanged prominent perivascular spaces in the bilateral middle frontal gyri, left greater than right, with what may represent surrounding gliosis. 4.Unchanged mildly low-lying tonsils.5.Unchanged presumed schwannoma at the C6-7.