The pediatric central skull base
This presentation is the property of its rightful owner.
Sponsored Links
1 / 39

The Pediatric Central Skull Base PowerPoint PPT Presentation


  • 67 Views
  • Uploaded on
  • Presentation posted in: General

The Pediatric Central Skull Base. Gary L. Hedlund, D.O. Primary Children ’ s Medical Center Salt Lake City, Utah. The Chondrocranium. Portion of the neocranium formed by endochondral ossification 25 centers of ossification 18 sutures and/or synchondroses

Download Presentation

The Pediatric Central Skull Base

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


The Pediatric Central Skull Base

Gary L. Hedlund, D.O.

Primary Children’s Medical Center

Salt Lake City, Utah


The Chondrocranium

  • Portion of the neocranium formed by endochondral ossification

  • 25 centers of ossification

  • 18 sutures and/or synchondroses

  • Anatomic variants and developmental anomalies abound


Central Skull Base

Jinkins JR . Atlas of Neuroradiologic Embryology, Anatomy, and Variants. 2000: LW&W


Newborn

Newborn Central Skull Base


Sphenooccipital Synchondrosis

NB

3 yrs

5 yrs


10 yrs

14 yrs

Sphenooccipital Synchondrosis


18-year-old female with closed head trauma


Neonatal Central Skull Base

6 Mo

Newborn


Craniopharyngeal Canal

5 yrs


Craniopharyngeal Canal

Larsen WJ. Human Embryology, 2ND ed. Saunders; 1997


Craniopharyngeal Canal

Courtesy Bronwyn E. Hamilton, MD


Infant Central Skull Base


Age Related T1WI Marrow Changes

Newborn

3 yrs

7 yrs


Sphenoid Bone Pneumatization

  • Follows marrow conversion

  • Begins at about 1 – 2 years

  • Reaches the sella by about 7 years

  • Mature by 15 years

  • Asymmetric pneumatization is common

  • Lateral recess pneumatization

    • Splays distance between f. rotundum & vidian canal


11-year-old boy with headache and lethargy

Leukemic marrow infiltration - ALL


Three-year-old with nasal congestion


Diagnostic Considerations?

  • Metastasis

  • Rhabdomyosarcoma

  • LCH

  • Chordoma

  • Chondrosarcoma


Langerhans’ Cell Histiocytosis

  • Denditic cell proliferation

  • Skull (calvarium>orbit>skullbase)

    • Mandible> ribs> femur> pelvis> spine

  • Imaging

    • Punched-out, beveled, lack of sclerosis

    • Sequestration +/-

    • T1 hyper - isointensity ~ lipid laiden histiocytes

    • T2 signal variable


Metastatic Disease

  • Leukemia

  • Neuroblastoma

  • Sarcomas

    • Rhabdomyosarcoma

    • Soft part sarcoma

    • Clear cell sarcoma


Seven-year-old female with headache and nasal congestion


Rhabdomyosarcoma

  • Most common childhood soft tissue sarcoma

  • More common in African American children

  • H&N involvement in 50%

    • Orbit

    • Parameningeal

      • Nasal cavity, NP, sinuses, parapharyngeal, masticator, pterygopalatine fossa, middle ear

    • Other

      • Cervical nonparameningeal


Imaging of Rhabdomyosarcoma

  • CT

    • Bony lysis

    • ST attenuation

  • MR

    T1 hypo to isointense

    T2 hyperintense

    Variable enhancement


NonrhabdomyosarcomaSoft Tissue Sarcomas (NRSTSs)

  • Fibrosarcoma

  • Primitive neuroectodermal tumor (PNET)

  • Malignant peripheral nerve sheath tumor

  • Ewing sarcoma

  • Synovial sarcoma


Six-year-old male with chronic headaches


Clival Chordoma

  • Primitive notocord remnant

  • Location

    • 35% skull base

    • 50% sacrococcygeal

    • 15% vertebral body


Clival Chordoma

  • T1WI

    • Intermediate to low signal

    • Focal hemorrhage

  • T2WI

    • High signal intensity

    • Heterogeneous

  • T1 C+

    • Honeycomb enhancement

Hemorrhage ~ 30%


Chordoma and TSC

  • TSC is a harmatoneoplastic syndrome

  • Autosomal dominant trait

  • Nonsense mutations in TSC1 (9q34)

    • Found in:

      • Symptomatic father

      • Clival chordoma of the son

Borgel J et al. Eur J Pediatr (2001) 160:138


Fourteen-year-old female with frontal headaches


Neurenteric Cyst

Kapoor V et al AJNR 23: 476-479, March 2002


Paraclival Neurenteric Cyst

  • Dysgenesis of notocord & neurenteric canal. Similar to Rathke cleft and colloid cysts

  • Most involve

    • Craniovertebral junction and posterior fossa

  • Histopathiology

    • Type A, resemble respiratory or GI epithelium

    • Type B, smooth muscle, glandular, and lymphoid

    • Type C, like Type B + glial elements


Summary

  • Review age related ossification and maturation

  • Identify anatomic variants

  • Review anomalies of development

  • Highlight pseudolesions and tumefactions of the central skull base


Thank you

[email protected]


  • Login