VHL and multiple hemangioblastomas. The evaluation for tumors is limited due to the lack of intravenous contrast. There are postoperative findings related to left transmastoid surgery with fat grafting, suboccipital craniotomy, as well as left enucleation with prosthesis. There are unchanged areas of confluent T2 hyperintensity in the bilateral cerebellar hemispheres with sulcal effacement. There is unchanged focal expansile T2 hyperintensity in the right cerebellar tonsil. There is also an unchanged focus of T2 hyperintensity in the left medulla. There are unchanged mild scattered foci of T2 hyperintensity in the cerebral white seen matter. There is a new fluid-fluid level within the right globe. The layering fluid measures up to 7 mm in thickness and is hypointense on T2 sequences and isointense on T1-weighted sequences, likely reflecting blood products. There is a right lens implant. There is no evidence of acute infarct. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The paranasal sinuses are unremarkable.
1. Persistent signal abnormality in the bilateral cerebellar hemispheres and left medulla may represent edema related to residual hemangioblastomas, although the lack of intravenous contrast limits evaluation.2. No definite evidence of recurrent endolymphatic sac tumor, although the lack of intravenous contrast limits evaluation.3. New fluid-fluid level in the right globe, which likely represents vitreous hemorrhage, perhaps related to an underlying hemangioblastoma, although the lack of intravenous contrast limits evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.