Neuro_MR_Skull_Base: 68 F, history of SCC of the right frontal sinus.

MRI SKULL BASE WITH AND WITHOUT CONTRAST:

 

CLINICAL HISTORY: 68-year-old woman, stage IVB squamous carcinoma of the right frontal sinus with dural, periorbital, and perineural invasion status post craniotomy.

 

FINDINGS:

 

Bones: Normal.

 

Soft tissues: Normal cavernous sinuses and visualized extracranial soft tissues.

Visualized skull base foramina: Normal.

Orbits: Normal.

Visualized paranasal sinuses: Postsurgical anatomy related to right frontal sinus inner table resection, including mesh, and heterogeneous signal involving the right frontal sinus is approximately unchanged.

Mild thickening and enhancement along the right orbital roof is unchanged.

 

Again seen is asymmetric thickening and enhancement of the right V3 nerve (series 13, image 10). There is also asymmetric enhancement in Meckel's cave (series 13, image 9), as well as enhancement of the cisternal segment of the right trigeminal nerve (series 12, image 15). There is equivocal asymmetric enhancement of the right cranial nerve V1 and probable enhancement of the right V2.

 

The right cranial nerves VII and VIII demonstrate abnormal enhancement along the cisternal segment, more pronounced versus prior (series 12, image 17). Additionally, as demonstrated on the prior study, there is asymmetric enhancement along the right greater superior petrosal nerve extending to Meckel's cave, and posteriorly along the extent of the right facial nerve interosseous segments.

 

There is new enhancement involving the right masticator space including the right temporalis muscle along its full extent (series 13, image 13).

 

Mastoid air cells: Clear.

 

Brain parenchyma: No acute hemorrhage, infarction, mass, or abnormal enhancement.

 

Ventricles and extra-axial spaces: Appropriate for age.

 

Additional comment: 8 mm enhancing right thyroid nodule (series 1601, image 26).

 

IMPRESSION:

 

1.  Redemonstration of perineural spread with asymmetric thickening and enhancement of the right V3 nerve, right Meckel's cave, and right cisternal segment trigeminal nerve. There is equivocal enhancement of the right cranial nerve V1 and probable enhancement of the right V2.

2.  Increased asymmetric enhancement of the right cranial nerves VII and VIII, including the right greater superior petrosal nerve, as well as cisternal and interosseous segments of the right facial nerve.

3.  Interval development of enhancement in the right masticator space, likely largely related to denervation atrophy, although areas of tumor infiltration such as the infratemporal fossa region of the auriculotemporal nerve remains a consideration.

4.  Unchanged postsurgical anatomy including mesh and heterogeneous signal involving the right frontal sinus.