Von-Hippel Lindau and pre-existing spinal hemangioblastomas. Also has inner ear canal lesion. Evaluate for growth and new hemangioblastomas in brain and spine. BRAIN: There is redemonstration of postoperative findings in the posterior fossa with unchanged minimal marginal T2 hyperintensity and susceptibility effect related to chronic hemosiderin deposition. There are multiple scattered subcentimeter enhancing nodules in the cerebellum bilaterally and dorsal to with minimal associated T2 signal intensity, likely representing vasogenic edema, unchanged. The largest of these lesions is within the left cerebellum and measures up to 8 mm, unchanged in size. There are also unchanged enhancing lesions within the medulla and left internal auditory canal, which have not significantly changed in size. There are postoperative changes are previous right frontotemporal craniotomy with a small peripheral area of encephalomalacia within the right lateral frontal lobe. In addition, there is a punctate enhancing lesion in the surgical cavity that appears to be unchanged. The ventricular sizes are unchanged. The basal cisterns remain patent. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable.SPINE: There are postoperative findings from previous C4-C6 laminoplasty, as well as multiple upper thoracic and upper lumbar laminectomies, with near-interval resolution of the paraspinal soft tissue enhancement in the upper thoracic spine region. There are numerous intramedullary leptomeningeal enhancing nodules throughout the spinal canal, many which are associated with prominent vascularity and edema, particularly of the lower thoracolumbar spine. The lesions do not appear to have significantly changed in size. The largest of these is along the conus measuring approximately 9 x 8 x 28 mm, but has not significantly changed in size. The vertebral body heights are preserved and disc spaces are unchanged. There is loss of usual cervical lordosis centered at C4/C5, which is unchanged. The rest of the spine alignment is intact. There is developmental narrowing of the cervical spinal canal with superimposed degenerative spondylitic disease resulting in unchanged moderate central canal stenosis at C4/5 and moderate to severe stenosis at C5/C6 with impingement upon the spinal cord. There is diffuse T2 hyperintensity in the posterior spinal cord at these levels. There is no significant spinal canal or neural foraminal stenosis in the thoracic or lumbar spine.
1. Postoperative findings in the posterior fossa and spine with multiple enhancing lesions throughout the infratentorial compartment and spine, as well as a punctate lesion in the right frontal lobe resection cavity, compatible with hemangioblastomas and appear stable. 2. A subcentimeter enhancing lesion within the left internal auditory canal also likely represents a hemangioblastoma or perhaps a vestibular schwannoma, but is unchanged. 3. Cervical spondylosis, congenital spinal canal narrowing, and laminoplasty with indentation upon the spinal cord. Signal abnormality at C4-5 to C6 suggestive of edema may be related to an hemangioblastoma and the spinal cord compression. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.