The patient came to the clinic 29-April-2014 complaining of difficult breathing fro the right nostril with progressive exophthalmus right eye for one year. He was operated for septal deviation elsewhere without benefit. CT-scan done 29-April-2014 showing a huge mass in the right maxillo- sphenoidal area, pushing the septum to the left and elevating the medial wall of the right orbit up and lateral.

On examination; the patient has no visual problems except the right exophthalmus. The lacrimal duct is closed and the tears are running outside the canal. It was possible to see the tumor through the right nostril. It was totally obstructing the passage.

The patient was sent for MRI investigations with contrast with MRA of the brain and carotid systems. There was no arterial involvement and the mass was totally extracranial, but reaching and abutting the pituitary floor and shifting the right optic nerve medially.

Through the right nostril, the tumor was attacked and piece-meal resection was performed. Fresh frozen biopsy telling that it is either meningioma or fibrous dysplasia. Inspection of the tumor bed cavity was negative. Intraoperative MRI done showing huge remnant of the tumor, which was followed and resected. Hemostasis. 2 nasal tubes were inserted.

Smooth postoperative recovery.

The patient is not characteristic for either meningioma, nor for fibrous dysplasia. It is benign and grossly looking as chordoma.

Intraoperative MRI is superior to the usual inspection, as in this case.