Imaging central skull base neural tumor spread from paranasal sinus malignancies: A critical factor in treatment planning

Eight cases of paranasal sinus tumors with central skull base disease are p resented. Each patient had coned down noncontrast and contrast-enhanced mag netic resonance imaging (MRI) studies to evaluate the tumor margins and any potential tumor spread into the cavernous sinuses, V2 and the Vidian nerve . Two patients had tumors that extended up to the face of the sphenoid bone and one had a tumor in the ventral cavernous sinus. These three patients h ad a complete tumor resection with postoperative irradiation. Two more pati ents had extensive tumor invasion of the central skull base, one was treate d with only irradiation, one refused treatment. Three more patients had tum ors that involved the ventral portion of the sphenoid bone with limited neu ral tumor extension. Two of these patients had surgery with cavernous sinus dissections followed by irradiation. One patient delayed treatment for 2 m onths and when he returned he had a more extensive tumor and was considered incurable by surgery. He refused further treatment. The technique of the f ocused MR examination and its impact on treatment planning is discussed.