Skip to main content
SpringerLink
Log in

Malignant Lesions of the Central and Posterior Skull Base

  • Chapter
Head and Neck Cancer Imaging

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

  • 3204 Accesses

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Aikele P, Kittner T, Offergeld C, Kaftan H, Huttenbrink KB, Laniado M (2003) Diffusion-weighted MR imaging of cholesteatoma in pediatric and adult patients who have undergone middle ear surgery. Am J Roentgenol 181:261–265

    CAS  Google Scholar 

  • Azar-Kian B, Sarwar M, Marc JA, Schlechter MM (1974) Intraosseous meningioma. Neuroradiology 6:246–253

    Article  Google Scholar 

  • Barber B, Ingram M, Khan S, Bano G, Hodson S, Vlahos I (2011) Clinicoradiological manifestations of paraganglioma syndromes associated with succinyl dehydrogenase enzyme mutation. Insights Imaging 2(4):431–438

    Article  Google Scholar 

  • Bolger WE, Reger C (2003) Temporal lobe encephalocele appearing as a lytic lesion of the skull base and pterygoid process. Ear Nose Throat J 82:268–272

    Google Scholar 

  • Bomanji JB, Hyder SW, Gaze MN, Gacinovic S, Costa DC, Coulter C, Ell PJ (2001) Functional imaging as an aid to decision-making in metastatic paraganglioma. Br J Radiol 74:266–269

    PubMed  CAS  Google Scholar 

  • Bourgouin PM, Tampieri D, Robitaille Y, Robert F, Bergeron D, del Carpio R, Melancon D, Ethier R (1992) Low-grade myxoid chondrosarcoma of the base of the skull: CT, MRI, and histopathology. J Comput Assist Tomogr 16:268–273

    Article  PubMed  CAS  Google Scholar 

  • Brewis C, Bottrill ID, Wharton SB, Moffat DA (2000) Metastases from glomus jugulare tumours. J Laryngol Otol 114:17–23

    PubMed  CAS  Google Scholar 

  • Brodeur GM, Castleberry RP (2001) Neuroblastoma. In: Pizzo PA, Poplack DG (eds) Principles and practice of pediatric oncology. Lippincott Williams & Wilkins, Philadelphia, p 796

    Google Scholar 

  • Burston BJ, Pretorius PM, Ramsden JD (2005) Gradenigo’s syndrome: successful conservative treatment in adult and paediatric patients. J Laryngol Otol 119:325–329

    Article  PubMed  Google Scholar 

  • Carlotti CG Jr, Drake JM, Hladky JP, Teshima I, Becker LE, Ruthka JT (1999) Primary Ewing’s sarcoma of the skull in children utility of molecular diagnostics, surgery and adjuvant therapies. Pediatr Neurosurg 31:307–315

    Article  PubMed  Google Scholar 

  • Casselman JW (2005) The skull base: tumoral lesions. Eur Radiol 15:534–542

    Article  PubMed  Google Scholar 

  • Chong VFH, Fan YF (1998) Radiology of the sphenoid bone. Clin Radiol 53:882–893

    Article  PubMed  CAS  Google Scholar 

  • Choyke PL, Glenn GM, Walther MM, Patronas NJ, Linehan WM, Zbar B (1995) Von Hippel Lindau disease: genetic, clinical and imaging features. Radiology 146:629–642

    Google Scholar 

  • Crawford TS, Kleinschmidt-DeMasters BK, Lillehei KO (1995) Primary intraosseous meningioma (Case report). J Neurosurg 83:912–915

    Article  PubMed  CAS  Google Scholar 

  • Cummings TJ, George TM, Fuchs HE, McLendon RE (2004) The pathology of extracranial scalp and skull masses in young children. Clin Neuropathol 23:34–43

    PubMed  CAS  Google Scholar 

  • De Foer B, Vercruysse JP, Pilet B, Michiels J, Vertiest R, Pouillon M, Somers T, Casselman JW, Offeciers E (2006) Single-shot, turbo spin-echo, diffusion-weighted imaging versus spin-echo-planar, diffusion-weighted imaging in the detection of acquired middle ear cholestatoma. Am J Neuroradiol 27:480–482

    Google Scholar 

  • De Foer B, Vercruysse JP, Bernaerts A et al (2010) Middle ear cholesteatoma: non-echo-planar diffusion-weighted MR imaging versus delayed gadolinium-enhanced T1-weighted MR imaging—value in detection. Radiology 255:866–872

    Article  PubMed  Google Scholar 

  • Dhepnorrarat RC, Wood B, Rajan GP (2009) Postoperative non-echo-planar diffusion-weighted magnetic resonance imaging changes after cholesteatoma surgery: implications for cholesteatoma screening. Otol Neurotol 30:54–58

    Article  PubMed  Google Scholar 

  • DiNardo LJ, Wetmore RF (1989) Head and neck manifestations of histocytosis-X in children. Laryngoscope 99:721–724

    Article  PubMed  CAS  Google Scholar 

  • Erdem E, Angtuaco EC, Van Hemert R, Park JS, Al-Mefty O (2003) Comprehensive review of intracranial chordomas. Radiographics 23:995–1009

    Article  PubMed  Google Scholar 

  • Evans HL, Ayala AG, Romsdahl MM (1977) Prognostic factors in chondrosarcoma of bone: a clinicopatholgogic analysis with emphasis on histologic grading. Cancer 40:818–831

    Article  PubMed  CAS  Google Scholar 

  • Farrior B, Kampsen E, Farrior JB (1981) The positive pressure of cholesterol granuloma idiopathic blue eardrum: differential diagnosis. Laryngoscope 91:1286–1296

    Article  PubMed  CAS  Google Scholar 

  • Filippi CG, Edgar MA, Ulug AM, Prowda JC, Heier LA, Zimmerman RD (2001) Appearance of meningiomas on diffusion-weighted images: correlating diffusion constants with histopathologic findings. Am J Neuroradiol 22:65–72

    PubMed  CAS  Google Scholar 

  • Forsyth PA, Cascino TL, Shaw EG, Scheithauer BW, O’Fallon JR, Dozier JC, Piepgras DG (1993) Intracranial chordomas: a clinocopathological and prognostic study of 51 cases. J Neurosurg 78:741–747

    Article  PubMed  CAS  Google Scholar 

  • Gandour-Edwards R, Kapadia SB, Janecka IP, Martinez AJ, Barnes L (1995) Biologic markers of invasive pituitary adenomas involving the sphenoid sinus. Mod Pathol 8:160–164

    PubMed  CAS  Google Scholar 

  • Garg V, Temin N, Hildenbrand P, Silverman M, Catalano PJ (2010) Inflammatory pseudotumor of the skull base. Otolarngol Head Neck Surg 142:129–131

    Article  Google Scholar 

  • Garland LH (1945) Osteogenic sarcoma of the skull. Radiology 45:45–48

    Google Scholar 

  • Goldofsky E, Hoffman RA, Holliday RA, Cohen NL (1991) Cholestrol cyst of the temoporal bone: diagnosis and treatment. Ann Otol Rinol Laryngol 100:181–186

    CAS  Google Scholar 

  • Gorham LW, Wrighte AW, Schulz HH, Maxon FC (1954) Disappearing bones: a rare form of massive osteolysis, report of two cases, one with autopsy findings. Am J Medicine 17:674–681

    Article  CAS  Google Scholar 

  • Gormley WB, Tomecek FJ, Qureshi N, Malic GM (1994) Craniocerebral epidermoid and dermoid tumours: a review of 32 cases. Acta Neurochir (Wien) 128:115–121

    Article  CAS  Google Scholar 

  • Gradenigo G (1904) Sulla leptomeningite circonscritta e sulla paralisi dell’ abducenta di origine otitica. Giornale dell’Accademia di medicina di Torino 10:59–84

    Google Scholar 

  • Greenberg JJ, Oot RF, Wismer GL, Davis KR, Goodman ML, Weber AE, Montgomery WW (1988) Cholesterol granuloma of the petrous apex: MR and CT evaluation. Am J Neuroradiol 6:1205–1214

    Google Scholar 

  • Guo AC, Cummings TJ, Dash RC, Provenzale JM (2002) Lyphomas and high-grade astrocytomas: comparison of water diffusibility and histological characteristics. Radiology 224:177–183

    Article  PubMed  Google Scholar 

  • Hassounah M, Al-Mefty O, Akhtar M, Jenkins JR, Fox JL (1985) Primary cranial and intracranial chordosarcoma: a survey. Acta Neurosurgica 78:123–132

    Article  CAS  Google Scholar 

  • Howarth DM, Gilchrist GS, Mullan BP, Wiseman GA, Edmonson JH, Schomber PJ (1999) Langerhans cell histocytosis: diagnosis, natural history, management, and outcome. Cancer 85:2278–2290

    Article  PubMed  CAS  Google Scholar 

  • Inserra MM, Pfeister M, Jackler RK (2004) Anatomy involved in the jugular foramen approach for jugulotympanic paragrangioma resection. Neurosurg Focus 17:41–44

    Article  Google Scholar 

  • Jabre A, Tabaddor R, Samaraweera R (2000) Transphenoidal meningoencephalocele in adults. Surg Neurol 54:183–187

    Article  PubMed  CAS  Google Scholar 

  • Joseph M, Rajshekhar V, Chandy MJ (2004) Haematopoietic tissue presenting as a sphenoid sinus mass: case report. Neuroradiology 42:153–154

    Article  Google Scholar 

  • Kaufman B, Bellon EM (1973) The trigeminal nerve cistern. Radiology 108:597–602

    PubMed  CAS  Google Scholar 

  • Kozlowski K, Cambell J, Mc Alister W, Babyn P, Cama A, Masel J, Pelizza A, Taccone A (1991) Rare primary cranial vault and base of skull tumours in children: report of 30 cases and short literature review. Radiol Med 81:213–224

    PubMed  CAS  Google Scholar 

  • Laigle-Donadey F, Tailliber S, Martin-Duverneuil N, Hildebrand J, Delattre JY (2005) Skull-base metastases. J Neurooncol 75:63–69

    Article  PubMed  Google Scholar 

  • Lang FF, Macdonald OK, Fuller GN, DeMonte F (2000) Primary extradural meningiomas: a report of nice cases and review of literature from the era of computerized tomography scanning. J Neurosurg 93:940–950

    Article  PubMed  CAS  Google Scholar 

  • Layer G, Steudal A, Schuller H, van Kaick G, Grunwald F, Riser M, Schild HH (1999) Magnetic resonance imaging to detect bone marrow metastases in the initial staging of small cell lung carcinoma and breast carcinoma. Cancer 85:1004–1009

    Article  PubMed  CAS  Google Scholar 

  • Liu JK, Gottfried ON, Amini A, Couldwell WT (2004) Aneurysms of the petrous internal carotid artery: anatomy, origins, and treatment. Neursurg Focus 17:1–9

    Article  Google Scholar 

  • Loevner LA, Tobey JD, Yousem DM, Sonners AI, Hsu WC (2002) MR imaging characteristic of cranial bone marrow in adult patients with underlying systemic disorder compared with healthy control subjects. Am J Neuroradiol 23:248–254

    PubMed  Google Scholar 

  • Luff DA, Simmons M, Malik T, Ramsden RT, Reid H (2002) Endolymphatic sac tumours. J Laryngol Otol 116:398–401

    PubMed  CAS  Google Scholar 

  • Mascalchi M, Filippi M, Floris R, Fonda C, Gasparotti R, Villari N (2005) Diffusion-weighted MR of the brain: methodology and clinical application. Radiol Med (Torino) 109:155–197

    Google Scholar 

  • Miller C, Lloyd TV, Johnson JC, Hunt WE (1978) Eosinophilic granuloma of the base of the skull: case report. J Neurosurg 49:464–466

    Article  PubMed  CAS  Google Scholar 

  • Moore KL, Dalley AF (1999) Head and neck. In: Moore KL, Dalley AF (eds) Clinically oriented anatomy, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 1093–1096

    Google Scholar 

  • Mukherji SK, Castillo M (1996) Adenocarcinoma of the endolymphatic sac: imaging features and preoperative embolization. Neurordaiology 38:179–180

    Article  CAS  Google Scholar 

  • Mukherji SK, Baggett HC, Alley J, Carrasco VH (1998) Enlarged cochlear aqueduct. Am J Neuroradiol 19:330–332

    PubMed  CAS  Google Scholar 

  • Price T, Fayad G (2002) Abducens nerve palsy as the sole presenting symptom of petrous apicitis. J Laryngol Otol 116:726–729

    PubMed  CAS  Google Scholar 

  • Ragel BT, Couldwell WT (2004) Pituitary carcinoma: review of the literature. Neurosurg Focus 16:1–9

    Article  Google Scholar 

  • Rao AB, Koeller KK, Adair CF (1999) From the archives of the AFIP: Paragangliomas of the head and neck: radiologic–pathologic correlation. Radiographics 19:1605–1632

    PubMed  CAS  Google Scholar 

  • Robert Y, Carcasset S, Rocourt N, Hennequin C, Dubrulle F, Lamaitre L (1995) Congenital cholesteatoma of the temporal bone: MR findings and comparison with CT. Am J Neuroradiol 16:755–761

    PubMed  CAS  Google Scholar 

  • Rueda-Franco F, Lopez-Correla E (1995) Sarcomas in the central nervous system of children. Pediatric Neurosurg 22:49–56

    Article  CAS  Google Scholar 

  • Salvati M, Ciappetta P, Capone R, Santoro R, Raguso M, Raco A (1993) Osteosarcoma of the skull in a child: a case report and review of the literature. Childs Nerv Syst 9:437–439

    Article  PubMed  CAS  Google Scholar 

  • Satter EK, High WA (2008) Langerhans cell histiocytosis: a review of the current recommendations of the Histiocyte Society. Pediatr Dermatol 25:291–295

    Article  PubMed  Google Scholar 

  • Schmalfuss IM (2009) Petrous Apex. Neuroimaging Clin N Am 19:367–391

    Article  PubMed  Google Scholar 

  • Schmalfuss IM, Camp M (2008) Skull Base: normal variants and Pseudolesions. Eur Radiol 18:1232–1243

    Article  PubMed  Google Scholar 

  • Sen C, Hague K, Kacchara R, Jenkins A, Das S, Catalano P (2001) Jugular foramen: microscopic anatomic features and implications for neural preservation with reference to glomus tumors involving the temporal bone. Neurosurgery 48:838–847

    PubMed  CAS  Google Scholar 

  • Shinoda J, Kimura T, Funakoshi T, Iwata H, Tange K, Kasai C, Miyata Y (1993) Primary osteosarcoma of the skull. J Neurooncol 17:81–88

    Article  PubMed  CAS  Google Scholar 

  • Smirniotopoulos JG, Chiechi MV (1995) Teratomas, dermoid, and epidermoids of the head and neck. Radiographics 15:1437–1455

    PubMed  CAS  Google Scholar 

  • Stone JA, Cooper H, Castillo M, Mukherji SK (2001) Malignant schwannoma of the trigeminal nerve. Am J Neuroradiol 22:505–507

    PubMed  CAS  Google Scholar 

  • Tauber M, van Loveren HR, Jallo G, Romano A, Keller JT (1999) The enigmatic foramen lacerum. Neurosurgery 44:386–391

    Article  PubMed  CAS  Google Scholar 

  • Tokgoz N, Oner YA, Kaymaz M, Ucar M, Yilmaz G, Tali TE (2005) Primary intraosseous meningioma: CT and MRI appearance. Am J Neuroradiol 26:2053–2056

    PubMed  Google Scholar 

  • Tunaci M, Tunaci A, Engin G, Ozkorkmaz B, Dincol G, Acunas G, Acunas B (1999) Imaging features of thalassemia. Eur Radiol 9:1804–1809

    Article  PubMed  CAS  Google Scholar 

  • Turner OA, Laird AT (1966) Meningioma with traumatic etiology. J Neurosurg 24:96–98

    Article  PubMed  CAS  Google Scholar 

  • Utz JA, Krandorf MJ, Jelinek JS, Moser RP Jr, Berrey BH (1989) MR appearance of fibrous dysplasia. J Comput Assist Tomogr 13:845–851

    Article  PubMed  CAS  Google Scholar 

  • Van Tassel P, Lee YY, Ayala A, Carrasco CH, Klima T (1991) Case report 680: intraosseous meningioma of the sphenoid bone. Skeletal Radiol 20:383–386

    Article  PubMed  Google Scholar 

  • Whitehead RE, Melhem ER, Kasznica J, Eustace S (1998) Telangiectatic osteosarcoma of the skull base. Am J Neuroradiol 19:754–757

    PubMed  CAS  Google Scholar 

  • Williams LS, Schmalfuss IM, Sistrom CL, Inoue T, Tanaka R, Seoane ER, Mancuso AA (2003) MR imaging of the trigeminal ganglion, nerve and the perineural vascular plexus: normal appearance and variants with correlation to cadaver specimens. Am J Neuroradiol 24:1317–1323

    PubMed  Google Scholar 

  • Williamson RA, Paueksakon P, Coker NJ (2003) Inflammatory pseudotumor of the temporal bone. Otol Neurotol 24:818–822

    Article  PubMed  Google Scholar 

  • Yildirim T, Agildere AM, Oguzkurt L, Barutcu O, Kizilkilic O, Kocak R, Alp Niron E (2005) MRI evaluation of cranial bone marrow signal intensity and thickness in chronic anemia. Eur J Radiol 53:125–130

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Malcolm Randall VA Medical Center and University of Florida College of Medicine, 1601 SW Archer Road, Gainesville, FL, 32608, USA

    Ilona M. Schmalfuss

Authors
  1. Ilona M. Schmalfuss
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ilona M. Schmalfuss .

Editor information

Editors and Affiliations

  1. University Hospital Leuven, Dept. Radiology, Katholieke Universiteit Leuven, Herestraat 49, Leuven, 3000, Belgium

    Robert Hermans

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Schmalfuss, I.M. (2011). Malignant Lesions of the Central and Posterior Skull Base. In: Hermans, R. (eds) Head and Neck Cancer Imaging. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_386

Download citation

  • DOI: https://doi.org/10.1007/174_2011_386

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-17868-9

  • Online ISBN: 978-3-642-17869-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation