Any brain tumor or other abnormalities. History of neurofibromatosis type 2, migraines, meningioma orbital ridge, ptosis. Brain/Orbits/IAC: Again seen are multiple extra-axial masses in the brain. The relatively largest of these is an enhancing lesion along the right anterior frontal convexity measures 23 x 26 x 18 mm in the AP, transverse, and craniocaudal dimensions. There is mass effect on the right superior frontal gyrus. Previously this lesion measured approximately 23 x 16 x 11 mm. There are multiple small additional lesions along the falx and convexities likely representing small meningioma and are stable to slightly larger compared to 7/7/2008 with differences in technique slightly limiting comparison.There is an 8 x 9 mm extra-axial lesion involving the interpeduncular cistern on the right which is also larger and may represent a schwannoma of the third nerve. Additional tiny lesion is seen on the left as well. There is a 17 x 13 mm lesion involving the right Meckel's cave which appear slightly larger.  There is a 7 x 8 mm area of abnormal enhancement at the right cerebellopontine angle at the nerve root entry zone of the seventh and eighth nerves which is increased since prior and suspected to represent a recurrent schwannoma at the right cerebellar pontine angle cistern. No significant mass effect. There is abnormal enhancement involving the right internal auditory canal which appears more confluent then prior. There are postsurgical changes of prior retrosigmoid craniotomy and encephalomalacia along the right lateral cerebellar hemisphere.There is abnormal enhancement involving the right geniculate ganglion measuring approximately 9 x 7 mm, previously approximately 6 x 6 mm on prior. There is subcentimeter area of abnormal enhancement at the level of the geniculate ganglion of the facial nerve on the left which is more prominent in the interval. There is enlargement of enhancing right orbital mass measuring 27x20x17 mm, previously 20 x 19 x 15 mm likely representing a right optic sheath meningioma. There is increased mass effect on the right optic nerve.There is a 18x14x18 mm enhancing lesion in the left parotid gland minimally large since prior and likely represents a schwannoma. Again seen are multiple T2/flair hyperintense foci involving the periventricular and subcortical white matter similar to prior. No significant intracranial mass effect aside from the right frontal lobe. No midline shift or herniation. No hydrocephalus. There is a nonspecific focus of T1 hyperintensity involving the right anterior ethmoid sinus.Lumbar Spine:Vertebral body heights in the lumbar spine are normal. Alignment is normal. Bone marrow signal is benign. There is no significant spinal canal or neural foramina stenosis. There is enhancing lesion involving the cauda equina nerve roots at the L2 level measuring approximately 6 x 5 x 7 mm and not significantly changed since 3/29/2007. There is also a 3-mm lesion involving the cauda equina nerve roots on the left at L2 level, which is better seen on the axial T2 sequence, and also appears to be present on prior. There are additional multiple lesions involving the cauda equina nerve roots as was noted previously but not well seen on the current study as the axial post gad sequence is motion degraded. No largely lesion however is seen.There is 4-cm T1 hyperintense lesion in the right adnexa which is incompletely evaluated and can be assessed with pelvic ultrasound as clinically appropriate.
1. Stigmata of neurofibromatosis type II with multiple enhancing masses likely representing meningiomas and schwannomas as detailed above. Although differences in technique limit direct comparison, there does appear to be enlargement with many of these lesions. 2. Relatively largest of the lesions is a right frontal meningioma measuring 23 x 26 x 18 mm and larger. There is mild associated mass effect.3. Right orbital mass likely representing optic nerve sheath meningioma is larger. 4. There is increase in enhancement of within the right internal auditory canal as well as a a small right cerebellopontine angle lesion which is slight larger suspected to represent tumor recurrence at site of prior resection. Right Meckel's cave, bilateral geniculate ganglia, left parotid, and interpeduncular cistern lesions also slightly larger likely representing schwannomas.5. Lumbar spine images again demonstrate multiple subcentimeter intradural extramedullary lesions involving the cauda equina nerve roots and not significantly enlarged since 3/29/2007.