64-year-old female with NF type 2, memory loss, seizures, and vestibular schwannomas. Evaluate for new meningiomas or other tumors. Again seen is evidence of a large prior left fronto-parietal craniotomy. There is also evidence of a previous right mastoidectomy with resection and distortion of the right middle and inner ears structures. Since the prior MRI from 1/11/2014, there has been mild interval increase in size of multiple meningiomas along the dura along the right cerebral hemisphere, falx and tentorium. There is mild increase in parenchymal edema in the right frontal subcortical white matter associated with the increase in size of right anterior frontal meningiomas. Dense calcifications associated with the meningiomas are better seen on prior CT.There has also been significant interval increase in the multiple extra-axial skull base masses especially along the right Meckel's cave, right cerebellopontine angle and anteriorly along the brain stem. For example the right medial temporal/Meckel's cave lesion has increased in size currently measuring 2.0 x 3.0 cm (series 1802, image 93), compared to 1.3 x 2.6 cm previously. This mass is causing mass effect and lateral displacement of the mesial temporal structures. The larger more lateral right CPA tumor measures 2.4 x 2.6 cm (series 1802, image 76), compared to approximately 1.5 x 2.1 cm previously although direct comparison is limited secondary to prior motion degradation. This is causing worsened mass effect on the adjacent cerebellum and brainstem. The smaller more medial CPA tumor is grossly unchanged in size measuring 1.1 x 1.3 cm (1802, image 78). The extra-axial mass anterior to the brainstem has increased considerably compared to the previous exam and now exerts significant mass effect on the adjacent pons and medulla. This lesion measures 2.4 x 2.5 cm (series 1802, image 70), 1.6 x 1.7 cm previously in the axial plane. Also increased is the craniocaudal extent of the tumor which measures 2.6 cm compared to 1.8 cm previously. Additional multiple smaller tumors are seen within the bilateral CPA, right greater than left Meckel's cave, right greater than left cavernous sinus. There is masslike thickening and enhancement involving the left IAC compatible with a vestibular schwannoma which has increased in size and has also extended more medially. Large right greater than left foraminal-based masses are visible at the C1-2 level which have increased in size compared to the prior exam. There is effacement of the lateral aspects of the thecal sac, right greater than left, and mild contour deformity of the upper cervical cord. Soft tissue enhancing lesions in the suboccipital soft tissues are also slightly larger.There is no evidence of intracranial hemorrhage or acute infarct. No hydrocephalus. Aside from the right frontal lobe T2/FLAIR hyperintensity which is increased in the interval, FLAIR hyperintensity in the left frontal lobe likely reflecting gliosis is unchanged. There is also encephalomalacia in the left posterior frontal lobe which is again seen. Mild leftward midline shift is not significantly changed.. The major cerebral flow voids are intact.
Innumerable extra-axial enhancing masses consistent with meningiomas and schwannomas involving the supra and infratentorial brain, greatest along the frontal lobes, right medial temporal lobe, right cerebellopontine angle, anterior to the pontomedullary junction, within the left IAC and along the bilateral C1-2 foramina, most of which have increased in size compared to the prior exam from 2014. In particular, the meningioma anterior to the brainstem has increased significantly and is now causing extensive mass effect on the ventral lower pons and upper medulla. There is also increase in parenchymal T2/FLAIR hyperintensity compatible with edema associated with the right anterior frontal meningiomas. Please see additional details above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.