Malignant Lesion of the Central and Posterior Skull Base
Imaging interpretation of skull base lesions can be challenging because of their infrequent occurrence, the complex nature of the skull base, and the ability of normal anatomical variations to mimic pathology. Since the majority of skull base lesions are
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Abstract
Introduction
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2 A natomy 2.1 C entral Skull Base 2.2 Posterior Skull Base
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Clinical Presentation
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Normal Anatomical Variations
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5 P athology 5.1 M alignant Lesions Causing Diffuse or Multi-focal Skull Base Involvement 5.2 Mimics of Malignant Lesions Causing Diffuse or Multi-focal Skull Base Involvement 5.3 Non-region Specific, Localized Malignant Skull Base Lesions 5.4 Mimics of Non-region Specific, Localized Malignant Skull Base Lesions 5.5 Malignant Central Skull Base Lesions 5.6 Mimics of Malignant Central Skull Base Lesions 5.7 Malignant Lesions at the Junction of Central to Posterior Skull Base 5.8 Malignant Posterior Skull Base Lesions 5.9 Mimics of Malignant Posterior Skull Base Lesions
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Imaging Protocol
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Radiologist’s Role
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References
Imaging interpretation of skull base lesions can be challenging because of their infrequent occurrence, the complex nature of the skull base, and the ability of normal anatomical variations to mimic pathology. Since the majority of skull base lesions are accidentally detected and inaccessible for biopsy, the clinicians heavily rely upon the accurate image interpretation by the radiologist. The main goals of the image analysis are to distinguish normal anatomical variations form true pathology, recognize medically treatable conditions, and to differentiate benign “do-not-touch” lesions from malignant processes that might require aggressive treatment. The imaging features and preferential location of the different malignant skull base lesions and their benign counterparts will be discussed in this chapter. After the diagnosis of a malignancy is established, the radiologist’s main role is the delineation of the extent of the suspected malignant skull base lesion for treatment planning process.
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1 Introduction I. M. Schmalfuss (*) Department of Radiology, North Florida/South Georgia Veterans Administration and University of Florida College of Medicine, Gainesville, FL, USA e-mail: [email protected]
Evaluation of skull base lesions is challenging. On the one hand, the skull base is not directly accessible for clinical evaluation, and an underlying lesion might be suspected based on
Med Radiol Diagn Imaging (2020) https://doi.org/10.1007/174_2020_231, © This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply
I. M. Schmalfuss
neurological deficits and/or nonspecific symptoms such as tinnitus or headache. On the other hand, cross-sectional radiological studies are excellent in demonstrating a skull base lesion and its extent, but their evaluation is intimidating to the majority of the radiologists. There are three main reasons for the intimidation of the radiologists: the anatomical complexity of the skull base, the ability of normal anatomical structures to mimic pathology, and the rarity of skull base
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