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Imaging of disease spread through the skull base

Imaging of disease spread through the skull base. Eufrozina Selariu Skåne Universitetssjukhus Malmö Sweden. Characterisation of the lesion. Morphology 1. tissue characterisation 2. pattern of bone involvment 3. vascularity Localisation 1. intrinsic to the skull base

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Imaging of disease spread through the skull base

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  1. Imaging of diseasespreadthrough the skull base Eufrozina Selariu Skåne Universitetssjukhus Malmö Sweden

  2. Characterisation of the lesion • Morphology 1. tissuecharacterisation 2. patternof boneinvolvment 3. vascularity • Localisation 1. intrinsic to the skull base 2. arrising from intracranialcompartment 3. arrising from extracranialhead and neck • Invasion of otherstructures 1. Direct extension • infiltratingbone, soft tissue, meninges, cerebrum • preformedchannels and foramina 2. Hematogenousspread 3. Perineuralspread

  3. GlomusJugulareParaganglioma

  4. Duralarteriovenousfistula

  5. Bone involvementpattern

  6. Agressiveboneinvolvementpattern Osteolysis • Absent bonereplaced by soft tissue • Thinnedbone with soft tissuemass on itsbothsides • Abnormal signal of the bonemarrow • Calcificationswithin the soft tissuemass

  7. Non-aggressiveboneinvolvementpattern • Bone remodeling with bowing, thin or demineralizedwalls • Bone expansion with smoothcontour or interruptedwalls • Enlargedintramedullarycavity • Varyingattenuation: ground-glass, radiolucent or sclerotic

  8. EosinophilicgranulomaClivusChordoma

  9. Juvenil Angiofibroma

  10. Pituitaryadenoma

  11. Direct extensionby preformedpathways

  12. Esthesioneuroblastoma Olfactoriusmeningioma

  13. TrigeminalNeurofibroma

  14. Sphenoidmeningioma Opticnervemeningioma

  15. Abscess MPS, PPS, MS, CS, RPS • Pharygealmucosalspace PMS Sinus Morgagni • Parapharyngealspace PPS Skull base • Carotidspace CS Canaliscaroticus Jugularforamen • Mandibularspace MS Foramen ovale • Retropharyngealspace RPS Basiocciput

  16. Direct extensionby infiltratingstructures

  17. Skull baseMetastasis • Occur in bone with high marrowcontent • Osteoblasticmetastasis • Hypervascularmetastasis • Osteolyticmetastasis

  18. Frontal sinus SquamousCell Carcinoma

  19. Nodular dural enhancing have high specificity Dural thickness > 5 mm Coexistent leptomeningeal enhancement Brain parenchymal changes Sinus frontalisSquamousCell Cancer with intracranialspread

  20. Hematogenousspread

  21. AcuteMastoiditis– Localcomplications • Subperiostealabscess • Sinus thrombosis • Bezold abscess • Perisinus and epidural abscess • Petrositis • Labyrintitis

  22. AcuteOtitisIntracranialcomplications Cavernous sinus thrombosis Enlargedsuperiorophtalmicveins Exophtalmus Inhomogenousenhancement of cavernous sinus

  23. AcuteOtitis - IntracranialcomplicationsSubduralempyemaMeningitisPetrousapicitis

  24. Perineuralspread Tumor growth Incresedpermeability of endoneurialcapillaries Rupture of the blood-nervebarrier Contrast-enhancement • Nerveenlargement and nerveenhancement • Obliteration of the fat in the foramina, fosse or fissures • Foraminalenlargement or destruction • Enhancing soft tissue in the cavernous sinus and Meckelcave • Neuropathicatrophy and fat replacement

  25. Perineuralspread • Adenoid cysticcarcinoma • Mucoepidermoidcarcinoma • Squamos cell carcinoma • Adenocarcinoma Blood-nervebarrierdisruption with segmental nerveenhancement • Inflammation – neuritis • Ischemia • Trauma • Demyelination • Axonal degeneration • Normal variant enhancement of Gasser ganglion and V2, V3

  26. EthmoidalAdenocarcinomawithperineuralspreadin pterigopalatinefossa

  27. Role of imaging • Diagnosis • Extentof disease – criteria of surgicalresectability • Treatmentplanning – surgical approach • Follow-up–reccurenceversusposttreatmentchanges

  28. Thank you !

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