 Brain: There is infiltrative mass centered in the right infratemporal fossa that measures up to approximately 4 cm, which extends along the right trigeminal nerve trunk into the cavernous sinus, Meckel's cave, right foramen rotundum, and the cisternal segment of the trigeminal nerve towards the brainstem. There also extension of tumor with cystic components along the floor of the right middle cranial fossa with mass effect upon the right temporal lobe, where there is mild vasogenic edema. However, there is no evidence of abnormal intra-axial enhancement. There are multiple foci of white matter T2 hyperintensity in the frontal lobes consistent with age indeterminate small vessel ischemic disease. There is no evidence of acute infarction or intracranial hemorrhage. The ventricles and sulci are normal. The facial nerve is unremarkable in appearance. The orbits are grossly unremarkable. The paranasal sinuses are grossly aerated. There is opacification of the right mastoid air cells.Neck: There are post-treatment findings in the right neck. The infratemporal fossa tumor extends laterally with extension in the right inferior alveolar canal. There is also diffuse enhancement and swelling of the masticator muscles. In addition, there is linear enhancement in the right parotid gland. The other remaining salivary glands are unremarkable. There is no significant lymphadenopathy in the neck. There are multilevel degenerative changes in the cervical spine.
1. Post-treatment findings in the right neck with a recurrent tumor centered in the right infratemporal fossa with infiltration of the right pterygoid muscle and perineural spread along the trigeminal nerve, with involvement of the right inferior alveolar canal, cavernous sinus, Meckel's cave, right foramen rotundum, and the cisternal segment of the trigeminal nerve towards the brainstem. In addition tumor extends along the floor of the right middle cranial fossa with mass effect upon the right temporal lobe, where there is mild vasogenic edema. 2. Linear enhancement in the right parotid gland may represent perineural tumor spread along the right facial nerve versus radiation neuritis. 3. Superimposed acute denervation changes in the right masticator muscles beyond the areas involved by tumor associated with compromise of the right trigeminal nerve.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.