Relapsed neuroblastoma with headache. The lobulated heterogeneous mass along the floor of the left middle cranial fossa and infratemporal fossa with perineural extension into the left cavernous sinus through foramen ovale and rotundum has slightly increased in size, measuring up to approximately 4.5 cm, previously 4.0 cm. In addition, tumor along the left lateral extraconal space appears to have slightly increase in size, measuring up to 11 mm in thickness, previously 7 mm, with mass effect upon the left lateral rectus muscle and compression of the left optic nerve in the orbital apex. An extradural nodule adjacent to the lateral inferior left frontal lobe now measures up to 7 mm, previously 5 mm, and display central non-enhancement. There is also interval increase in size of the tumors along the bilateral mandibular condyles, measuring up to 22 mm in overall width on the right, previously 15 m, and 13 mm in overall width on the left, previously 11 mm. There is no evidence of intracranial hemorrhage or acute infarct. There is mild mega cisterna magna. Otherwise, the ventricles and basal cisterns are normal in size and configuration. There is no midline shift. There is scattered paranasal sinus mucosal thickening and secretions. There is obstructed fluid within the left mastoid air cells.
1. Interval increase in size of tumor along the left lateral wall of the orbit with associated compression of the left optic nerve at the orbital apex.2. Slight interval increase in size of the mass along the floor of the left middle cranial fossa and infratemporal fossa with apparent perineural extension into the left cavernous sinus through foramen ovale and rotundum, as well as associated left Eustachian tube obstruction.3. A subcentimeter extradural lesion adjacent to the inferior left frontal lobe laterally has slightly increased in size and now appears to be partly necrotic.4. Interval increase in size of the tumors along the bilateral mandibular condyles.