This case of advanced nasopharyngeal carcinoma with skull base invasion illustrates well the anatomy of the head and neck and skull base.

Although this patient had renal impairment and could not receive post-contrast sequences the anatomy is well illustrated on the T1 and T2 fat saturation with respect to the tumor.

The annotated images show the various sites of tumor extension/invasion, especially those that enter different neck spaces.

This case illustrates trans-spatial disease. The nasopharyngeal tumor extending into the:

• right carotid space
• right masticator space
• prevertebral space
• buccinator space

and in addition, the skull base, including the cavernous sinus and clivus.

The concomitant imaging of the skull base with CT for bony delineation is a must.  Unfortunately, this patient failed to attend for CT of the skull base.

Radiological stage: T4, N3a, Mx.

From a clinical perspective, the trigeminal nerve palsy is likely due to nerve involvement in the lateral wall of the right side of the cavernous sinus and the glossopharyngeal nerve from the tumor encircling the right IJV and ICA, where this nerve courses.