Hodgkin's lymphoma, preoperative evaluation. MRI brain: Please note, sequences of the brain are limited for presurgical planning and includes 3-D T2 and post gadolinium 3-D T1 sequences. Again seen is persistent diffusely enhancing tumor centered in the right lateral skull base region with soft tissue extension into the right upper deep neck spaces, right cerebellomedullary cistern, right jugular foramen, hypoglossal canal, right Meckel's cave extending to the posterior right cavernous sinus as seen on prior MRI. There is persistent diffuse enhancement of the bone marrow involving the right lateral and central skull base as seen on the prior exam. There is persistent right tympanomastoid opacification.There is redemonstration of bilateral optic disc protrusion and prominence of the optic sheaths compatible with intracranial hypertension.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.MRV brain: There is tumor involving the right jugular foramen with occlusion of the upper right internal jugular vein. Tumor appears to extend intracranially at the level of the right sigmoid sinus and resulting in partial occlusion of the right sigmoid sinus. More proximally, there is diminished flow/partial thrombosis involving the right transverse sinus. The right jugular vein more distally is patent as seen on recent CT neck study from 3/31/2016.There is heterogeneous signal involving the posterior aspect of the superior sagittal sinus suspected to represent partial thrombosis with preserved flow more anteriorly and posteriorly in the superior sagittal sinus. Nondominant/hypoplastic left transverse and sigmoid sinuses are are patent as is the left internal jugular vein.The straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent.
1. Limited sequences of MRI brain for presurgical planning redemonstrates right lateral skull base tumor with enhancing soft tissue extension into the upper deep neck spaces and intracranial extension along the right jugular foramen, hypoglossal canal, right Meckel's cave, and posterior inferior aspect of the right cavernous sinus compatible with known lymphoma.2. Occlusion of the upper right internal jugular vein at the level of the tumor which involves the jugular foramen. The right internal jugular vein more inferiorly is patent as demonstrated on CT neck from 3/31/2016. There is partial thrombosis and slow flow involving the right sigmoid sinus and right transverse sinus. There is also irregularity involving the posterior aspect of superior sagittal sinus suspicious for partial thrombosis. The superior sagittal sinus more anteriorly and posteriorly however remain patent. The nondominant/hypoplastic left transverse sinus, sigmoid sinus, and jugular vein remain patent.3. Persistent right tympanomastoid effusion.4. Papilledema and prominence of the optic nerve sheath are compatible with elevated intracranial pressure. 