Locally advanced T4N3 NPC recurrence with right eye ptosis and diffuse right face numbness, and vision changes. There is an enhancing mass that measures up to 4 cm within the right cavernous sinus and Meckel's cave with extension into the adjacent right middle cranial fossa and petrous apex, with marked mass effect upon the right anterior temporal lobe, where there is extensive vasogenic edema and uncal medialization. There appears to be mild enhancement of the cisternal segment of the right trigeminal nerve, but the brainstem is intact. In addition, the tumor partly encases the right cavernous internal carotid artery, which appears to be mildly narrow. Tumor also extends through foramen ovale along a 10 mm length of the V3 segment trigeminal nerve, as well as into the right pterygopalatine fossa via foramen rotundum and Vidian canal. The tumor also extends to the geniculate ganglion region, where there appears to be mild thickening of the facial nerve in this region. Furthermore, the tumor abuts and mildly displaces and partly surrounds the right prechiasmatic optic nerve. Aside from post-treatment effects, there is no discernible tumor in the right lateral nasopharyngeal recess. There is no evidence of acute cerebral infarction. The ventricular system is not enlarged.
Recurrent tumor measures up to 4 cm within the right cavernous sinus, Meckel's cave, and right middle cranial fossa, with marked mass effect upon the right anterior temporal lobe, with associated extensive vasogenic edema. The tumor partly encases the right cavernous internal carotid artery, which appears to be mildly narrow. Tumor also extends through foramen ovale along a 10 mm length of the V3 segment trigeminal nerve, as well as into the right pterygopalatine fossa via foramen rotundum and Vidian canal, indicating perineural tumor spread. In addition, the tumor also extends to the geniculate ganglion region, where there appears to be mild thickening of the facial nerve in this region, which may represent further perineural involvement versus reactive changes. Furthermore, the tumor abuts and mildly displaces and partly surrounds the right prechiasmatic optic nerve. Follow up via an orbital MRI may be useful for more detailed evaluation of this region. Aside from post-treatment effects, measurable tumor is identified within the right lateral nasopharyngeal recess.