Diagnosis: Headache Personal history of other diseases of the nervous system and sense organsClinical question: h/o clival chordoma s/p resection x 2, apparent recurrence on HCTSigns and Symptoms: h/o clival chordoma s/p resection x 2, apparent recurrence on HCT, c/o headache dizziness, slurred speech Since prior exam of 2004 the mass associated with the left half of the clivus extending into the left cerebellopontine angle cistern has enlarged. The mass extends down to the left cerebellar medullary angle cistern. The exophytic intracranial component now measures approximately 40 x 25 mm axial dimensions and 35 x 25 mm sagittal dimensions. The mass displaces the left cranial nerves VII and VIII as well as the left trigeminal nerve. It compresses the brainstem and displaces it and distorts it. It invaginates into the pons. The mass is heterogeneous in appearance on T1 and T2 imaging and known to contain calcifications. There are small cystic components associated with it.The component within the sphenoid bone is associated with expansion into the right middle cranial fossa which was also present on the prior exam and is also identified on CT. The internal carotid arteries are displaced laterally - especially the right internal carotid artery. The pituitary gland is displaced superiorly.There is metal artifact present adjacent to the left parietal bone. This distorts the imaging appearance of the left hemisphere. Ventriculostomy tube courses through the left frontal lobe into the left lateral ventricle with tip in the region of the foramen of Monro.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 right internal carotid arteries significantly displaced towards the right this includes the petrous portion of the right carotid canal in the cavernous portion of the right internal carotid artery. The basilar artery and posterior cerebral arteries as well as the superior cerebellar arteries drape around the posterior fossa tumor.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.
1.Since the prior exam from 2004, the exophytic component of a clival mass has significantly increased in size and invaginates into the brainstem and displaces adjacent structures. This mass is known to represent a chordoma.2.The patient is status post ventriculostomy tube placement. The lateral ventricles are not dilated on the current exam