European Radiology

, Volume 18, Issue 6, pp 1232–1243 | Cite as

Skull base: pseudolesion or true lesion?

Head and Neck

Abstract

The skull base is a complex anatomical structure. Therefore, radiologists often use “side-to-side” comparison for detection of abnormalities. This approach is compromised by the high frequency of anatomical variations involving the skull base and the common presence of flow-related artifacts within vessels at the skull base that might mimic true lesions. The spectrum of “pseudolesions” ranging from different anatomical variations, such as unusual arachnoid granulations, asymmetric pneumatization and/or appearance of neurovascular foramina, to flow-related artifacts will be discussed in this review article, and tips for their distinction from a true lesion in a similar location will be given.

Keywords

Skull base Normal variants Pseudolesions Symmetric pneumatization Symmetric skull base foramina 

References

  1. 1.
    Virapongse C, Sarwar M, Bhimani S, Sasaki C, Shapiro R (1985) Computed tomography of temporal bone pneumatization: 1. Normal pattern and morphology. AJR 145:473–481PubMedGoogle Scholar
  2. 2.
    Mikami T, Minamida Y, Koyanagi I, Baba T, Houkin K (2007) Anatomical variations in pneumatization of the anterior clinoid process. J Neurosurg 106:170–174PubMedCrossRefGoogle Scholar
  3. 3.
    Morton ME (1983) Excessive pneumatization of the sphenoid sinus: a case report. J Maxillofac Surg 11:236–238PubMedCrossRefGoogle Scholar
  4. 4.
    Walker JL, Jones NS (2002) Pneumosinus dilatans of the frontal sinuses: two cases and a discussion of its etiology. J Laryngol Oto 116:382–385Google Scholar
  5. 5.
    Acar M, Yucel A, Degirmenci B, Yilmaz MD, Albayrak R (2004) Pneumocele vs. pneumosinus dilatans: Review of the literature with a case of frontal sinus pneumocele. Tohoku J Exp Med 202:295–297PubMedCrossRefGoogle Scholar
  6. 6.
    Urken ML, Som PM, Lawson W, Edelstein D, Weber AL, Biler HF (1987) Abnormally large frontal sinus. II. Nomenclature, pathology and symptoms. Laryngoscope 97:606–611PubMedGoogle Scholar
  7. 7.
    Haetinger RG, Navarro JAC, Liverti EA (2006) Basialr expansion of the human sphenoidal sinus: an intergrated anatomical and computerized tomography study. Eur Radiol 16:2092–2099PubMedCrossRefGoogle Scholar
  8. 8.
    van Schayck R, Niedeggen A (1992) Pneumosinus dilatans after prolonged cerebrospinal fluid shunting in young adults with cerebral hemiatrophy. A report of two cases and review of the literature. Neurosurg Rev 15:217–223PubMedCrossRefGoogle Scholar
  9. 9.
    Sener RN (1997) Arachnoid cyst and pneumosinus dilatans. Comput Med Imaging Graph 21:125–129PubMedCrossRefGoogle Scholar
  10. 10.
    Corey SA, O’Donovan CA (2005) Sturge-Weber Syndrome and Accompanying Dyke-Davidoff-Masson Syndrome. Arch Neurol 62:1928–1929PubMedCrossRefGoogle Scholar
  11. 11.
    Hirst LW, Miller NR, Hodges III FJ, Corbett JJ, Thompson S (1982) Sphenoid pneumosinus dilatans a sign of meningioma originating in the optic canal. Neuroradiol 22:207–210CrossRefGoogle Scholar
  12. 12.
    Vauterin T, Mombaerts I, Jorissen M, Sciot R, Legiud E (2005) Pneumosinus dilatans and orbital meningioma in neurofibromatosis type 2. B ENT 1:89–92PubMedGoogle Scholar
  13. 13.
    Suryanarayanan R, Abbott G (2007) Pneumosinus dilatans: demonstrated by sinus expansion on serial sinus X-rays with discussion of possible aetiology. J Laryngol Otol 121:96–99PubMedCrossRefGoogle Scholar
  14. 14.
    Koesling S, Kunkel P, Schul T (2005) Vascular anomalies, sutures and small canals of the temporal bone on axial CT. Europ J Radiol 54:335–343CrossRefGoogle Scholar
  15. 15.
    Ginsberg LE, Pruett SW, Chen MYM, Elster AD (1994) Skull-base foramina of the middle cranial ossa: Reassessment of normal variations with high-resolution CT. AJNR Am J Neuroradiol 15:283–291PubMedGoogle Scholar
  16. 16.
    Shapiro R, Robinson F (1967) The foramina of the middle fossa: A phylogenetic, anatomic and pathologic study. AJR 101:779–794Google Scholar
  17. 17.
    Henderson WR (1966) A note on the relationship of the human maxillary nerve to the cavernous sinus and to an emissary sinus passing through the foramen ovale. J Anat 100:905–908PubMedGoogle Scholar
  18. 18.
    Lindblom K (1936) A roentgenographic study of the vascular channels of the skull, with special reference to intracranial tumors and arteriovenous aneurysms. Acta Radiol (Suppl) 30:1–146Google Scholar
  19. 19.
    Atilla S, Akpek S, Uslu S, Ilgit ET, Işik S (1995) Computed tomographic evaluation of surgically significant vascular variations related with the temporal bone. Eur J Radiol 20:52–56PubMedCrossRefGoogle Scholar
  20. 20.
    Verbist B, Hermans R, Devlies F, DeFoer B, Baert AL (1996) Quiz of the month. Partial agenesis of the internal carotid artery with collateral circulation through an enlarged inferior tympanic artery. Eur Radiol 6:939–940PubMedCrossRefGoogle Scholar
  21. 21.
    Kuroiwa T, Kajimoto Y, Ohta T, Tsutsumi A (1996) Symptomatic hypertrophic pacchionian granulation mimicking bone tumor: case report. Neurosurg 39:860–862CrossRefGoogle Scholar
  22. 22.
    Okamoto K, Ito J, Tokiguchi S, Furusawa T, Nishihara M (1997) Arachnoid granulations of the posterior fossa: CT and MR findings. Clin Imaging 21:1–5PubMedCrossRefGoogle Scholar
  23. 23.
    Celli P, Cervoni L, Quasho R (1999) An asymptomatic hypertrophic pacchionian granulation simulating osteolytic lesions of the calvaria. Neurosurg Rev 22:149–151PubMedCrossRefGoogle Scholar
  24. 24.
    Perry BP, Rubinstein JT (2000) Meningitis due to acute otitis media and arachnoid granulations. Ann Otol Rhinol Laryngol 109(9):877–879PubMedGoogle Scholar
  25. 25.
    Yamaguchi S, Hirohata T, Sumida M, Arita K, Kurisu K (2002) Intradiploic arachnoid cyst identified by diffusion-weighted magnetic resonance imaging-case report. Neurol Med Chir 42:137–139CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2008

Authors and Affiliations

  1. 1.North Florida/South Georgia Veterans AdministrationGainesvilleUSA
  2. 2.Department of RadiologyUniversity of FloridaGainesvilleUSA

Personalised recommendations