 There are postoperative changes consistent with C1 and C2 laminectomy for tumor resection at the C1 level bilaterally. Partial resection of the bilateral intradural tumor component is seen, as well as partial resection of bilateral extradural tumor at C1 and C2. Some intradural and extradural tumor does remain at these levels. This residual tumor, along with a post-operative collection of mixed fluid and blood product in the posterior operative bed, contributes to a persistent severe effacement of the thecal sac. In particular, the thecal sac is narrowed in the transverse dimension with significant cord deformation and questionable cord T2 hyperintensity. Additional post-operative findings include dural and pial enhancement in the operative field which are within expected limits. The previously noted enhancing oval mass in the left posterior paraspinal soft tissues at C2 is unchanged in size and measures 26 x 17 mm. A right-sided paraspinal apical pleural space mass which measures approximately 20 mm and is not significantly changed. Likewise, several tumor nodules along the pleural surface of the right lung apex are unchanged. Extensive tumor nodularity in the left paraspinal space at the thoracic inlet is partially visualized, extending into the left hemithorax and depressing the left lung apex. This aggregate lesion is only partially visualized on today's exam, but that portion which is seen does not appear to have changed. From the level of C2 and below, every neural foramen is filled and expanded by tumor, similar to prior. Kyphosis of the cervical spine is again seen, not significantly changed. Vertebral body heights are maintained. No concerning marrow replacement is seen. Except as above, the spinal cord shows normal morphology and signal.
1. There are postoperative changes consistent with C1 and C2 laminectomy for tumor resection. There has been partial resection of bilateral intradural tumor at C1 as well as bilateral extradural tumor at C1 and C2. Significant bilateral transverse narrowing of the thecal sac does persist, however, due to residual tumor and post-operative fluid. The spinal cord is significantly impinged and may be edematous. 2. Multiple additional paraspinal tumors and tumor aggregates, as well as diffuse foraminal neurofibromas, show no significant interval change.