13-year-old male with NF type II, facial weakness, brain tumor. Evaluate for interval change in vestibular schwannoma and schwannoma the right facial nerve, change in brain tumor. MRI BRAIN: There is evidence of prior right parietal craniotomy. No restricted diffusion to suggest acute ischemia. Gray-white matter differentiation is preserved. No discrete intraparenchymal lesions are identified, however see below regarding lesions within the internal auditory canals and brain stem. The ventricles and sulci are appropriate for patient's age. There is no midline shift or herniation.MRI IAC: Bilateral enhancing lesions within the internal auditory canals are again noted and not significantly changed from prior study. These lesions demonstrate low T1 signal and T2 signal with homogeneous enhancement. The lesion on the right measures 6 mm x 6 mm (series 2701, image 11) and occupies the majority of the intracanalicular portion of the inferior vestibular division and to a lesser degree the superior vestibular division and cochlear division of the vestibulocochlear nerve. The lesion on the left measures 7 mm x 5 mm (series 2701, image 8) and also occupies a similar pattern of the vestibulocochlear divisions although a to lesser extent. The intracanalicular portion of the facial nerves appear to be spared bilaterally. There are postoperative changes of the right petrous bone. In particular, enhancing lesions of the right petrous bone adjacent to the right internal auditory canal and posterior mastoid air cells are likely reflecting postoperative granulation tissue or mixed with residual tumor. Although direct comparison to the prior study dated 8/24/2014 is not entirely possible due to difference in slice thickness, the above findings are overall not significantly change.MRI CERVICAL SPINE: There is interval change in MR characteristics of the medullary lesion. The lesion shows increase in size of the lesion within the spinal cord at the level of the medulla which was relatively homogeneous low T1 and high T2 signal intensity before. The lesion also demonstrates interval increase in size. It is measured 2.5 cm x 1.8 cm x 1.4 cm which was previously 1.4 cm x 1.4 cm x 1.2 cm. Given the signal characteristics and the patient's history of neurofibromatosis type II, this is compatible with a spinal cord ependymoma. Additional smaller enhancing lesion in the spinal cord at the level of C2 measuring up to 9 mm (series 2301, image 10) has also increased in size comparing to prior study with a new additional lesion at the level of C2/C3 disc space spinal cord anterior aspect (series 2501, image 9). These lesions likely represent another ependymomas. Also at the level of C1-2 posterior arch there is a lesion within which arises peripherally overlying the spinal musculature and appears to encase the left side C2 nerve root; a portion of the lesion also abuts the posterior inferior aspect of the left vertebral artery. The lesion is isointense on T1, bright but subtle internal low signal intensities on T2 and demonstrates homogeneous enhancement. This likely represents a neurogenic tumor such as a schwannoma. The lesion is measured 4.0 cm x 2.9 cm x 2.9 cm (series 2501, image 5). This also appears slightly increased in size on the prior study.
1. Bilateral vestibular schwannomas compatible with patient's known history of Neurofibromatosis II which are not significantly changed in size. Postoperative changes along the petrous bone and posterior mastoid air cells appear similar to prior study; this likely represents postoperative granulation tissue or mixed with residual tumor.2. Medullary ependymoma has increased in size since the prior study with changed MR characteristics (more heterogeneous T2 signal, development of cystic component and inhomogeneous enhancement). 3. Spinal cord ependymoma at the level of C2 has increased in size since prior scan.4. Another spinal cord ependymoma at the level of C2-C3 level mid-anterior aspect of the spinal cord.5. Mass lesion between C1 and C2 posterior arch, located adjacent to the left vertebral artery, likely represents a neurogenic tumor such as schwannoma. This has slightly increased in size since the prior study.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.