Recurrent stage IV neuroblastoma status post radiation therapy. Assess for response. Redemonstration of a lobulated heterogeneous mass centered in the left masticator space and infratemporal fossa. The mass extends into the left middle cranial fossa. There is also perineural extension into the cavernous sinus through the left foramen rotundum and ovale. Overall the mass is slightly decreased in size. There is more marked interval decrease in size of the middle temporal cranial fossa component of the tumor which used to measure 12 mm in craniocaudal dimension and now only measures 2 mm. The dural based nodule adjacent to the anterolateral left frontal lobe is no longer identified compatible with resolution. No foci of abnormal enhancement within the brain parenchyma. The ventricles are normal in size and configuration. The basal cisterns are preserved. The expected intracranial vascular flow voids are present.The previously noted tumor masses along the posterior mandibular condyles has resolved. There remains poorly defined soft tissue enhancement compatible with posttreatment change. The visualized mandibular condyles have minimally decreased marrow signal and expansion also possibly reflecting treatment change. Near complete opacification of the paranasal sinuses is slightly progressed compared to prior. Persistent opacification of the left mastoid air cells compatible with eustachian tube dysfunction appears similar to prior.Orbits:The tumor extends from the infratemporal fossa into the inferolateral extraconal left orbit. The intraorbital component now measures 9 mm, previously 12 mm. There is still persistent mass effect on the optic nerve and lateral rectus muscles.
Overall decrease in tumor burden in the visualized head and orbits. There has been interval resolution of the perimandibular masses and marked interval decrease in the extension of tumor into the left middle cranial fossa. More mild interval decrease in size of the main infratemporal mass and left intraorbital tumor component. 