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A 46-YEAR-OLD man presented with a longstanding history of dull headache and intermittent dark, bloody nasal discharge. He had recently been complaining of a shooting pain over the right temple. There was no history of hearing loss, dizziness, facial weakness, numbness, or diplopia. Physical examination of the ear, nose, throat, and neck revealed no abnormalities. Cranial nerves II to VIII were intact, and the findings of diagnostic flexible nasal endoscopy were normal.Magnetic resonance imaging showed a 5ϫ3-cm lesion invading the skull base and extending into the sphenoidal sinus on both sides, mainly on the left side. The lesion had a heterogeneous hyperintense signal on T 1 -