Diagnosis: Neoplasm of unspecified behavior of respiratory system Neoplasm of uncertain behavior of brain, unspecified. Encounter for other preprocedural examinationClinical question: growth of sphenoid sinus/posterior fossa tumor, MRA and a MRI STEALTH for presurgery planning. No fiducials neededSigns and Symptoms: imaging for image guidance during surgery, and details of anatomy MRI of the brainThere is a mass centered in the left cavernous sinus involving the left sphenoid sinus involving the left sphenoid bone which displaces the cavernous LICA laterally. It extends into the left sphenoid sinus and left pterygomaxillary fossa. It protrudes into the lateral aspect of the pituitary fossa. It appears very vascular with multiple flow voids. It has significantly enlarged relative to the prior exam from 8/13/12.The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There is a vascular mass centered in the left cavernous sinus. Arterial supply can be identified from the LICA, RICA and left internal maxillary artery branches including the left middle meningeal artery.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is no stenosis of the left ICA at the level of the known cavernous sinus mass.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating arteries are intact and medium size. The vertebral arteries are similar in size.
1.There is a vascular mass centered in the left cavernous sinus which appears to erode into the adjacent sphenoid bone and extend into the sphenoid sinus, pterygomaxillary fossa and pituitary fossa,. Arterial supply can be identified from the LICA, RICA and LECA branches. It has significantly enlarged relative to the prior exam from 8/13/12.2.The MRI of the brain is a limited exam for the purpose of stereotactic guidance during surgery.