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SKULL BASE REVIEW AND PATHOLOGY Melissa Durand Hartford Hospital Noon Conference October 20, 2006 PowerPoint PPT Presentation


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SKULL BASE REVIEW AND PATHOLOGY Melissa Durand Hartford Hospital Noon Conference October 20, 2006. Skull Base Anatomy Review. Skull Base Boundaries Upper surface of ethmoid bones and orbital plate of frontal bone to the occiptal bone. Three Key Bones Sphenoid Temporal Occipital.

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SKULL BASE REVIEW AND PATHOLOGY Melissa Durand Hartford Hospital Noon Conference October 20, 2006

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SKULL BASE

REVIEW AND PATHOLOGY

Melissa Durand

Hartford Hospital Noon Conference

October 20, 2006


Skull Base Anatomy Review

  • Skull Base Boundaries

  • Upper surface of ethmoid bones and orbital plate of frontal bone to the occiptal bone

  • Three Key Bones

  • Sphenoid

  • Temporal

  • Occipital


Skull Base Anatomy Review

Temporal Bone

Temporal bone- petrous portion

Sphenoid Bone

Occipital Bone

  • Key Fissures

  • Petrosphenoidal fissure

  • Petrooccipital fissure

  • Key Sutures

  • Sphenosquamous Suture

  • Occipitomastoid Suture


Skull Base Anatomy Review

  • Key Openings

  • Foramen spinosum

  • Foramen ovale

  • Foramen lacerum

  • Foramen rotundum

  • Foramen magnum

  • Foramen of vesalius

  • Jugular foramen

  • Superior orbital fissure

  • Inferior orbital fissure

  • Optic canal

  • Vidian canal

  • Hypoglossal canal

  • Pterygopalatine fossa


Skull Base Anatomy Review


Pterygopalatine fossa

Pterygoid canal

Foramen rotundum- higher level

Foramen ovale

Sphenoid spine- lower level

Petro-occipital fissure

Skull Base Anatomy Review

f. lacerum

Foramen spinosum


Skull Base Anatomy Review

  • Foramen magnum

  • Medulla oblongata

  • Vertebral arteries

  • Anterior/Posterior spinal arteries

  • Hypoglossal canal

  • CN XII

  • Hypoglossal artery

*

*


Skull Base Anatomy Review

  • Jugular Foramen

  • Pars nervosa: CN IX, inferior petrosal sinus

  • Pars vascularis: CN X, XI, jugular bulb

*

* Carotid canal


  • Foramen Ovale

  • CN V3

  • Lesser petrosal nerve

  • Accessory meningeal artery

  • Emissary veins

  • Foramen of Vesalius

  • Emissary vein

  • Accessory meningeal artery- asc intracranial branch

Skull Base Anatomy Review

  • Foramen Spinosum

  • Middle meningeal artery/vein

  • CV V3, recurrent branch

  • Lesser superficial petrosal nerve


Skull Base Anatomy Review

  • Foramen Lacerum

  • Ascending pharyngeal artery- meningeal branch

  • Nerve of pterygoid canal

  • Vidian Canal

  • aka pterygoid canal

  • Pterygopalatine fossa - foramen lacerum

  • Vidian nerve

  • Vidian artery


Skull Base Anatomy Review

  • Foramen rotundum

  • CN V2

  • Artery of foramen rotundum

  • Emissary veins


Skull Base Anatomy Review

  • Pterygopalatine Fossa

  • Pterygopalatine ganglia V2

  • Pterygopalatine plexus

  • Communicates with:

  • Inferior orbital fissure

  • Orbital apex

  • Sphenopalatine foramen

  • Pterygomaxilary fissure

  • Foramen rotundum

  • Vidian canal

  • Greater/lesser palatine canals and foramina


Skull Base Anatomy Review

Cavernous Sinus

Receives:Superior opthalmic vein Inferior opthalmic vein Sphenoparietal sinus

Drains via: Petrosal sinuses Basilar plexus Pterygoid plexus

Connection: Circular sinus

Contains: CN III, IV, V1, V2, VI

  • Meckel’s Cave

  • Posterior aspect of cavernous sinus

  • Gasserian ganglion (sensory root ganglion of CN V)


  • Inferior Orbital Fissure

  • Infraorbital artery, vein, and nerve (V2 branch)

  • Optic Canal

  • Optic nerve

  • Opthalmic artery

Skull Base Anatomy Review

  • Superior Orbital Fissure

  • CN III, IV, V1, VI

  • Middle meningeal artery- orbital branch

  • Recurrent meningeal artery

  • Superior opthalmic vein


Skull Base Anatomy Review

  • Key Openings

  • Foramen spinosum

  • Foramen ovale

  • Foramen lacerum

  • Foramen rotundum

  • Foramen magnum

  • Foramen of vesalius

  • Jugular foramen

  • Superior orbital fissure

  • Inferior orbital fissure

  • Optic canal

  • Vidian canal

  • Hypoglossal canal

  • Pterygopalatine fossa


Skull Base Pathology

Meningioma

Metastases

Myeloma

Neuroma

Schwannoma

Vascular Aneurysm

Chordoma

Chondrosarcoma

Dermoid tumors

Epidermoid tumors

Glomus tumors


Case 1


Chondrosarcoma

  • CT Findings:

  • Irregular, destructive mass

  • Centered off midline

  • Petro-occipital fissure

  • Calcifications, 70%; “rings/arcs”

  • MRI Findings:

  • Low T1 signal, high T2 signal

  • Enhance with contrast

  • Scalloped, well circumsribed margins


Chondrosarcoma

  • Origin:

  • Preexisting cartilaginous lesion, synchondroses, cartilage endplates

  • Location:

  • Paranasal sinuses, skull base, parasellar region

  • Long bones, pelvis, sternum, ribs

  • Clinical:

  • 45 yo, median age

  • Classic, mesenchymal, or dedifferentiated


Case 2


Chordoma

  • CT/MRI Findings:

  • Expansile lytic lesion, midline

  • Well delineated mass arising from bone

  • Large soft tissue component

  • Variable calcification

  • Anteroposterior extension

  • Heterogeneous enhancement on T1, T2

  • Dark on T1, bright on T2

  • DDx:

  • Chondroma

  • Chondrosarcoma

  • Clivus meningioma


Chordoma

  • Origin

  • Notochord remnants

  • Location

  • Clivus 35%

  • Sacrum 50%, Vertebral bodies 15%

  • Clinical

  • age 30-70

  • Slow growing, locally aggressive

  • CN VI- CN deficits

  • Mets late

  • Tx: surgery, radiation


Case 3


Glomus Tumor

  • Glomus jugulare CT/MRI Findings:

  • Center: jugular foramen

  • Limit: hyoid bone

  • Enhance w/ contrast

  • Salt and pepper appearance on MRI

  • Bone erosion


Glomus Tumor

  • Origin:

  • Chemoreceptor cells

  • Location:

  • 10% multiple

  • glomus jugulare: jugular bulb

  • glomus tympanicum: cochlear promontory;

  • Clinical:

  • Pulsatile tinnitus

  • Hearing loss

  • arrythmia, BP fluctuation


References

Erdem E, et al, “Comprehensive Review of Intracranial Chordoma”, Radiographics 2003; 23: 995-1009.

Grossman, R et al, Neuroradiology: The Requisites, Mosby, Philadelphia, 2003

Peretti P et al, “Chordoma”, www.emedicine.com/Radio/topic169.htm, 2005.

Pluta R et al, “Glomus Tumors”, www.emedicine.com/med/topic2994.htm, 2006.

Small J et al, “Chondrosarcoma”, http://brighamrad.harvard.edu/education/online/tcd/tcd.html.

Weissleder, R et al, Primer of Diagnostic Imaging, Mosby, Philadelphia, 2003

http://www.med.wayne.edu/diagRadiology/Anatomy_Modules/axialpages/Home_Page.html


Jennings Pond, Chester, CT


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