NF 2, status post resection of schwannoma and meningioma. Per chart, specimens sent were meningioma of C1, schwannoma of the craniocervical junction, meningioma of C5, schwannoma of the C3-4 right-sided foramen. Compared to 8/19/2015, there is interval postsurgical changes of suboccipital craniectomy and resection of the posterior arch of C1. Laminoplasties are also noted from C3 to C6. There is been resection of the previously seen extra-axial enhancing mass at the craniocervical junction dorsally, one of which appeared more rounded and one which was smaller and broad-based along the posterior aspect of the dura, best seen on 4/2/2015. There is also resection of extra-axial lesions involving the C4 and C5 levels. Again seen are multiple residual enhancing lesions throughout the cervical spine and partially imaged brain including nodular intramedullary lesions involving the cervical cord at the C1 and C2 levels which may represent ependymomas given history of NF 2. Enhancing masses seen involving the right C2 nerve root and a smaller one on the left compatible with schwannomas.C2-C3: Enhancing left nerve root with mild expansion of the neural foramina likely represents a schwannoma. There is mild intraspinal extension without significant cord deformity.C3-C4: No enhancing lesions. No spinal or neuroforaminal stenosis. C4-C5: Expansile lesion involving the right neural foramen again seen with intraspinal extension and mild residual mass effect on the right aspect of the cord. Partial resection as described above. T2 hyperintensity within the right aspect of the cord.C5-C6: Large, predominantly extraforaminal lesion on the right. Small enhancing extra foraminal lesion on the left is likely unchanged. No spinal canal stenosis.C6-C7: Small, predominantly extraforaminal enhancing lesions bilaterally without expansion of the foramina. No spinal canal stenosis.C7-T1: Small predominantly enhancing extraforaminal enhancing bilaterally lesions without expansion of the foramina, likely unchanged. No spinal canal stenosis.There is a relatively large lesion involving the peripheral aspect of the C6 nerve root extending to the brachial plexus. Additional smaller schwannomas partially visualized within the thoracic spine. Vertebral body heights are normal. Mild focal kyphotic angulation at the C5-C6 level is again seen. Postsurgical changes include extra-axial fluid collection in the suboccipital soft tissues which may represent a small pseudomeningocele and/or seroma. Extra-axial blood products along the dorsal spinal canal are also seen extending from the C3 to the C6-C7 levels which partially effaces the dorsal thecal sac without significant stenosis.There is abnormal T2 signal within the right hemicord at the C4 level without enhancement compatible with edema. Enhancing mass is seen on the prior images compressing the cord at this level. Mild degree of T2 hyperintensity is also noted involving the medulla and cervical cord extending to the lower C2 level and also present on preoperative study.Limited view of the oral cavity demonstrates increased T2 signal at the level of the right hemitongue raising question of denervation. However this finding is not definitively assessed due to presence of an endotracheal tube and partial visualization of the oral cavity.
1. Postsurgical changes related to resection of extra-axial enhancing masses involving the craniocervical junction/C1 level as well as in the cervical spine. There is interval increase in T2 signal noted within the right hemicord at the C4 level without enhancement compatible with edema. Enhancing mass is present compressing the cord at this level on the preoperative study. 2. Expected postsurgical changes include fluid collection at the C1-C2 level dorsal to the thecal sac which may represent a pseudomeningocele. Small extra-axial collection extending from C3 to the C6-C7 levels including the laminoplasty is also noted resulting in mild spinal canal stenosis without frank cord compression. 3. Stigmata of NF 2 with multiple enhancing lesions likely representing schwannomas, meningiomas, and tiny ependymomas.4. T2 hyperintensity and enhancement involving the right aspect of the tongue. Endotracheal tube and partial coverage makes evaluation difficult but suggests possibility of acute denervation changes.