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Skull Base Imaging

Skull Base Imaging

Vincent Chong

(2017)

Additional Information

Book Details

Abstract

Use today’s latest technology and methods to optimize imaging of complex skull base anatomy. This practical reference offers expert guidance on accurate preoperative lesion localization and the evaluation of its relationship with adjacent neurovascular structures.

  • Features a wealth of information for radiologists and surgeons on current CT and MR imaging as they relate to skull base anatomy.
  • Covers localizing skull base lesions, reaching the appropriate differential diagnosis, and deciding which surgical approach is best.
  • Consolidates today’s available information and guidance in this challenging area into one convenient resource.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Skull Base Imaging i
Skull Base Imaging iii
Copyright iv
Contributors v
Preface ix
Contents xi
1 - Anterior Skull Base 1
ANATOMY 1
KEY IMAGING CONSIDERATIONS 1
Anterior Cranial Fossa Invasion 2
Orbital Invasion 3
ANTERIOR SKULL BASE NEOPLASMS 4
Squamous Cell Carcinoma 4
Esthesioneuroblastoma 6
Adenocarcinoma 7
Adenoid Cystic Carcinoma 7
Sinonasal Lymphoma 7
Sinonasal Undifferentiated Carcinoma 7
Sarcoma 7
Meningioma 9
NONNEOPLASTIC LESIONS 10
Fungal Sinusitis 10
Mucocele 13
Fibrous Dysplasia 14
CONCLUSION 15
REFERENCES 17
2 - Imaging of the Paranasal Sinuses and Their Surgical Relevance 21
THE NASAL SEPTUM AND NASAL MUCOSA 21
FRONTAL SINUS DRAINAGE PATHWAY 21
Anterior Ethmoid Cells/Frontal Recess Cells 22
Agger Nasi Cells 22
ETHMOID BONE 23
Middle Turbinate and Basal Lamella 24
Middle Turbinate Variants 24
Ethmoid Bulla 25
Ethmoid Infundibulum 27
Uncinate Process 28
Uncinate Process Variations 30
Ethmoid Roof 30
Anterior Ethmoid Artery 32
Crista Galli 33
Ethmoid Air Cells 33
Haller cells 34
Onodi cells (sphenoethmoidal cells) 34
SPHENOID SINUS 34
Sphenoethmoidal Recess 34
Sphenoid Sinus Variations 34
CONCLUSION 35
REFERENCES 37
3 - The Sphenoid Bone 39
NORMAL ANATOMY 39
SPHENOID BODY 39
LESSER WING 39
GREATER WING 40
PTERYGOID PROCESSES 42
SPHENOID BONE DISORDERS 44
Sphenoid Sinus 44
Foramen ovale, rotundum, and the vidian canal 52
Bone 52
CONCLUSION 55
REFERENCES 63
4 - Imaging in Endoscopic Endonasal Skull Base Surgery 65
INTRODUCTION 65
HISTORICAL PERSPECTIVE 65
PREOPERATIVE PLANNING 66
Surgical Approaches and Anatomic Limitations 69
Sagittal plane 70
Transcribriform. Typical disorders in the anterior cranial fossa accessed via the transcribiform approach include sinonasal tumo... 70
Transplanum. The transplanum approach to the suprasellar cistern and third ventricle allows the surgeon direct access without ha... 70
Transsellar. The transsellar approach allows access to sellar lesions, such as pituitary adenomas and Rathke cleft cysts (this m... 71
Transclival. The clivus is divided into the upper, middle, and lower thirds anatomically by the neural foramina. The upper third... 71
Transodontoid. The transodontoid approach allows access to the inferior clivus, foramen magnum, and C1-C2 vertebrae 71
Coronal plane 72
Transorbital (orbital apex/superior orbital fissure/orbit). The transorbital approach allows access to orbital lesions, such as ... 72
Medial petrous. The medial petrous apex is accessed via the medial petrous approach. Typical disorders involving the petrous ape... 72
Transpterygoid (suprapetrous and infrapetrous modules). The suprapetrous and infrapetrous modules are both accessed by a common ... 72
Contraindications 72
Skull Base Reconstruction 73
POSTOPERATIVE IMAGING 75
Early Postoperative Imaging 75
Late Postoperative Imaging 77
COMPLICATIONS 77
Intraoperative Complications 77
Early Postoperative Complications 78
Late Postoperative Complications 79
CONCLUSION 79
REFERENCES 81
5 - Temporal Bone Inflammatory and Infectious Diseases 83
INTRODUCTION 83
EXTERNAL EAR: EXTERNAL OTITIS 83
External Otitis 83
Necrotizing External Otitis 83
MIDDLE EAR AND MASTOID: OTOMASTOIDITIS 83
Acute Otomastoiditis and Coalescent Mastoiditis 83
Petrous Apicitis 85
Chronic Otomastoiditis Without Cholesteatoma 85
Chronic Otomastoiditis With Cholesteatoma 90
INNER EAR: LABYRINTHITIS 90
Acute Stage Labyrinthitis 92
Fibrous Stage Labyrinthitis 92
Ossifying Stage Labyrinthitis 92
FACIAL NERVE 94
CONCLUSION 94
ACKNOWLEDGMENTS 96
REFERENCES 96
6 - Temporal Bone Tumors 99
7 - Temporal Bone Trauma 145
TEMPORAL BONE PSEUDOFRACTURES—FRACTURE MIMICS 145
TEMPORAL BONE FRACTURES 148
COMPLICATIONS OF TEMPORAL BONE FRACTURES 151
Fistulous Communications 151
Conductive Hearing Loss 153
Sensorineural Hearing Loss 157
Ossicular Fractures 161
Facial Nerve Injury 161
CONCLUSION 165
REFERENCES 167
8 - Update on Imaging of Hearing Loss 169
INTRODUCTION 169
IMAGING MODALITIES 169
SENSORINEURAL HEARING LOSS 171
Congenital SNHL Pathologies 171
Acquired SNHL Pathologies 176
CONDUCTIVE HEARING LOSS 182
Congenital Conductive Hearing Loss 182
Acquired Conductive Hearing Loss 184
MIXED HEARING LOSS 192
MHL Pathologies 192
CONCLUSION 192
DISCLOSURE 192
REFERENCES 192
9 - Imaging of the Facial Nerve 197
ANATOMY 197
Supranuclear Control 197
Motor Component 197
Sensory, Special Sensory, and Parasympathetic 197
Peripheral Course 198
Vascular Supply of the Facial Nerve 200
CLINICAL AND IMAGING EVALUATION 200
CONGENITAL ANOMALIES 202
VASCULAR DISORDERS OF THE FACIAL NERVE 203
Venous Vascular Malformations 203
FACIAL NERVE TRAUMA 205
INFLAMMATORY DISORDERS 206
TUMORS OF THE FACIAL NERVE 207
Schwannomas 207
Perineural Spread of Malignancy 209
CONCLUSION 211
REFERENCES 211
10 - Imaging of the Postoperative Middle Ear, Mastoid, and Internal Auditory Canal 215
INTRODUCTION 215
TRANSCANAL APPROACH 215
RETROAURICULAR AND ENDAURAL APPROACHES 215
Meatoplasty and Canaloplasty 215
Myringoplasty 215
Tympanoplasty 216
Ossiculoplasty 216
Imaging After Stapedectomy 218
Mastoidectomy 218
FACIAL RECESS APPROACH 220
Atticotomy 220
IMAGING THE POSTOPERATIVE MASTOID 220
MR Diffusion Imaging for Cholesteatoma 220
Superior Canal Dehiscence—Postoperative Imaging 222
Imaging of the Postoperative Internal Auditory Canal and Cerebellopontine Angle 223
RETROSIGMOID APPROACH 224
TRANSLABYRINTHINE APPROACH 225
MIDDLE CRANIAL FOSSA APPROACH 225
TWO-STAGE SURGERY FOR VS 225
COMPLICATIONS 225
POSTOPERATIVE IMAGING 226
SUMMARY 227
REFERENCES 228
11 - Petrous Apex 233
INTRODUCTION 233
ANATOMY 233
CLINICAL PRESENTATIONS 234
ANATOMIC VARIATIONS AND PATHOLOGIC ENTITIES OF THE PETROUS APEX 234
Aberrant internal carotid artery 235
Petrous segment internal carotid artery aneurysm 235
Narrow internal auditory canal syndrome 235
Schwannoma 236
Petrous apex effusion 236
Giant air cell 238
Petrous apex cephaloceles 238
Arachnoid granulations 238
Trauma 238
Petrous apex mucoceles 239
Fibrous dysplasia 240
Paget disease 240
Petrous apex osteomyelitis 242
Petrous apex cholesteatomas 242
Langerhans cell histiocytosis 243
Chondrosarcoma 243
Endolymphatic sac tumor 243
Metastatic disease 243
Plasmocytoma/multiple myeloma 244
Lymphoma 244
Paraganglioma 244
Nasopharyngeal carcinoma 244
REFERENCES 245
12 - Imaging of the Cerebellopontine Angle 247
INTRODUCTION 247
ANATOMY 247
IMAGING TECHNIQUES 247
Magnetic Resonance Imaging 247
Computed Tomography 247
EXTRAAXIAL LESIONS 248
Vestibular Schwannoma 248
Other Schwannomas 251
Meningioma 251
Hemangiopericytoma 251
Epidermoid Cysts 251
Arachnoid Cysts 254
Dermoid Cysts 255
Lipomas 255
Neurenteric Cysts 256
Metastases 257
INFECTIOUS/INFLAMMATORY LESIONS 257
Neurosarcoidosis 257
Tuberculosis 258
Neurocysticercosis 258
SKULL BASE LESIONS 258
Cholesterol Granuloma 258
Paraganglioma (Glomus Tumors) 259
Chondromas and Chondrosarcomas 259
Chordoma 259
Endolymphatic Sac Tumors 259
Petrous Apicitis 259
INTRAAXIAL LESIONS 259
Glioma 259
Choroid Plexus Papilloma 259
Lymphoma 260
Hemangioblastoma 260
Ependymoma 261
Medulloblastoma 262
Metastases 262
VASCULAR LESIONS 262
Cavernoma 262
OSSEOUS LESIONS 262
CONCLUSION 262
REFERENCES 266
13 - Jugular Foramen 269
APPLIED ANATOMY OF THE JUGULAR FORAMEN 269
JUGULAR BULB VARIANTS AND ANOMALIES 272
High-Riding and Dehiscent Jugular Bulb 272
Jugular Bulb Diverticulum 273
Jugular Bulb Pseudolesion 273
VASCULAR CONDITIONS OR LESIONS 273
Dural Arterial Venous Fistula 273
Jugular Vein Thrombosis 275
PRIMARY NEOPLASMS OF THE JUGULAR FORAMEN 276
Paragangliomas (Glomus Jugulare and Jugulotympanicum) 277
Jugular Foramen Schwannoma 279
Primary Jugular Foramen Meningioma 279
SECONDARY JUGULAR FORAMEN NEOPLASMS 282
Metastatic Disease to Skull Base or Dura 282
Skull Base Tumors 283
Infiltration by Other Adjacent Tumors 285
INFECTIVE AND INFLAMMATORY LESIONS 285
CONCLUSION 285
REFERENCES 287
14 - Imaging of the Craniovertebral Junction 291
EMBRYOLOGY AND CONGENITAL ANOMALIES 291
MEASUREMENT COMMONLY USED IN EVALUATING THE CRANIOVERTEBRAL JUNCTION 291
CONGENITAL ANOMALIES 291
MALFORMATIONS OF THE OCCIPITAL BONE 291
Platybasia 291
Basilar Invagination (Basioccipital Hypoplasia, Basilar Impression) 291
Condylar Hypoplasia 293
Condylar Dysplasia (Condylus Tertius, Third Occipital Condyle) 293
MALFORMATIONS OF THE ATLAS 293
Atlas Assimilation (Atlantooccipital Assimilation, Occipitalization of the Atlas) 293
Aplasia and Hypoplasia of the Atlas 294
Atlas Arch Anomaly 296
MALFORMATIONS OF THE AXIS AND ODONTOID PROCESS 296
Aplasia or Hypoplasia of the Dens 296
Persistent Ossiculum Terminale (Bergmann Ossicle) 297
Ossiculum Odontoideum (Os Odontoideum) 297
Klippel-Feil Anomaly 297
FRACTURE 298
Clivus Fracture 298
Occipital Condyle Fracture 299
Atlas Fracture 300
Axis Fracture (Odontoid Fracture) 302
DEGENERATIVE LESIONS OF THE CVJ 302
Degenerative Arthritis 302
Ossification of the Posterior Longitudinal Ligament 304
Diffuse Idiopathic Skeletal Hyperostosis 304
Retroodontoid Pseudotumor 305
INFECTIOUS/INFLAMMATORY LESIONS OF THE CVJ 306
Rheumatoid Arthritis 306
Ankylosing Spondylitis 308
Calcium Pyrophosphate Dihydrate Deposition Disease 309
Pyogenic and Nonpyogenic Infection 310
Osteoradionecrosis 310
TUMOR AND TUMOR-LIKE LESIONS 311
Chondrosarcoma 314
Miscellaneous benign bone tumors 315
Miscellaneous malignant bone tumors 316
Malignant lesions from adjacent soft tissue 316
Nerve sheath tumors 318
Congenital Cystic Lesions 318
VASCULAR LESIONS 320
Bow Hunter Syndrome 320
Vertebral Artery Aneurysm at the Foramen Magnum 320
Vertebral Artery Arteriovenous Fistula 320
Dural Arteriovenous Fistulas 320
DAVF at the foramen magnum 321
Anterior condylar DAVF (hypoglossal-clival DAVF) 322
REFERENCES 325
15 - Skull Base Bone Lesions I: Imaging Technique, Developmental and Diffuse Bone Lesions 329
INTRODUCTION 329
IMAGING TECHNIQUE 329
GENERAL IMAGING FEATURES OF BONE LESIONS HELPFUL IN THE DIFFERENTIAL DIAGNOSIS 331
Developmental Bone Lesions of the Skull Base 332
Lesions Originating From Embryonic Remnants 334
Diffuse Bone Lesions or Tumor-Like Conditions 341
SUMMARY 347
REFERENCES 347
16 - Skull Base Bone Lesions II: Benign and Malignant Tumors 351
INTRODUCTION 351
BONE TUMORS 351
Benign Tumors 351
Bone-forming tumors 351
Cartilage-forming tumors 356
Tumors without osteoid or chondroid matrix 358
Malignant Bone Tumors (Primary and Secondary) 362
SUMMARY 369
REFERENCES 369
17 - Neurointerventional Radiology for Skull Base Lesions 373
EMBOLIZATION OF HYPERVASCULAR TUMORS LOCATED AT THE SKULL BASE 373
GOALS OF PREOPERATIVE EMBOLIZATION 373
FUNCTIONAL ANATOMY 373
EMBOLIC MATERIALS 374
Particulate Embolic Materials 374
Liquid Embolic Materials 374
METHODS OF EMBOLIZATION 375
Transarterial Embolization 375
Embolization by Direct Puncture 377
COMPLICATIONS 379
JUVENILE ANGIOFIBROMA 379
TYMPANOJUGULAR PARAGANGLIOMAS 380
EMBOLIZATION FOR VASCULAR LESIONS IN THE SKULL BASE 382
Dural Arteriovenous Fistula 382
Classification, clinical presentation, and diagnosis 383
Principles of endovascular treatment 384
Transarterial and transvenous embolization 384
Embolic agents 385
Ancillary techniques and alternative approaches 385
Postprocedural care and follow-up 389
Outcome of endovascular treatment 389
Alternative treatments 389
Traumatic Carotid-Cavernous Fistula 390
Clinical features and diagnosis 390
Principle of treatment 390
Endovascular methods 390
Postprocedural care and follow-up 393
Outcome 394
Alternative treatments 394
REFERENCES 394
Index 401
A 401
B 401
C 401
D 402
E 403
F 404
G 404
H 404
I 405
J 405
K 406
L 406
M 406
N 406
O 407
P 407
R 408
S 408
T 409
U 410
V 410