Male, 15 years old, with neurofibromatosis type II who had a thoracic laminectomy in April for compression, now with some upper back pain. Since the prior examination, the acute postoperative findings compatible with laminectomy at T3-T5 have resolved. The thecal sac is expanded and there is no longer any significant epidural fluid. The large intradural tumor seen at the T4 level on preoperative imaging was resected and there is no evidence of residual or recurrent tumor. There is, however, a progressive kyphotic angulation of the upper thoracic spine with the maximum curvature centered at T3-T6.An intradural extramedullary tumor within the left lateral aspect of the spinal canal at C4 is unchanged. Multiple smaller enhancing lesions are also seen likely affecting the nerve roots including a lesion at C7 on the right and multiple small foci along the conus and partially visualized cauda equina. None of these lesions have significantly changed. Also redemonstrated are multiple enhancing lesions within the substance of the spinal cord. The superiormost of these lesions at the C2 level appears slightly more conspicuous but this may be due to differences in technique. None of the lesions demonstrates a convincing change in size, and no new lesions are detected. Apart from the exaggerated upper thoracic kyphosis, spinal alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics remain within normal limits.T2 signal abnormality abnormality is partially visualized in the right cerebellum, probably unchanged.
1.Since the prior examination, acute postoperative findings compatible with laminectomy and tumor resection from T3 through T5 have resolved. No evidence of residual or recurrent meningioma is seen at the operative site.2.A worsening kyphotic angulation of the upper thoracic spine is noted which could potentially relate to the patient's symptoms.3.Multiple additional intradural extramedullary lesions are redemonstrated without significant interval change.4.Multiple intramedullary enhancing lesions are again seen which most likely represent ependymomas. No convincing interval change is seen in these lesions and no new lesions are detected.