Relapsed neuroblastoma treated with 4 cycles chemotherapy. Orbits: The lobulated heterogeneous mass arising from the left lateral orbital wall has not significantly changed in size, measuring up to approximately 3.0 cm, previously also approximately 3.0 cm, with extension into the left lateral extraconal space and bulging into the left masticator space via subperiosteal extension. There is mass effect upon the left orbital contents, but the optic nerve is not directly compressed. The tumor displays less enhancement and restricted diffusion overall. The right orbit is unremarkable.Brain: There are postoperative findings related to left pterional craniotomy. There is tumor involving the left greater wing of the sphenoid, pterygoid process, and body of the sphenoid, which measures up to approximately 35 mm, with associated mass effect upon the adjacent brain parenchyma and parapharyngeal space contents. The tumor also protrudes into the left sphenoid sinus and abuts the left internal carotid artery. The tumor displays less enhancement and restricted diffusion overall. There is no evidence of intracranial hemorrhage or acute infarct. There is a left cerebellar hemisphere developmental venous anomaly. The ventricles are normal in size and configuration. There is no midline shift. There is diffuse paranasal sinus mucosal thickening and secretions. There is fluid and mucosal enhancement within the bilateral middle ears and mastoid air cells.
1. No significant interval change in size of the metastasis arising from the left lateral wall of the orbit. However, the tumor displays less enhancement overall, perhaps due to treatment-related necrosis. 2. No significant interval change in size of the metastasis involving the left greater wing of the sphenoid, pterygoid process, and body of the sphenoid. However, the tumor displays less enhancement overall, perhaps due to treatment-related necrosis. 3. Diffuse paranasal sinus mucosal thickening and secretions.4. Persistent fluid within the left middle ears and mastoid air cells likely attributable to obstruction of the Eustachian tube by tumor.