Skull-Base Tumors and Related Disorders

Radiological Approach
  • Jan W. Casselman
  • Stephanie Vanden BosscheEmail author
  • Elias Pretorius
  • Bert De Foer
Living reference work entry


Skull base lesions can be a diagnostic challenge due to the complex anatomy, technical challenges in magnetic resonance imaging of the region, the possibility of pseudotumors, and a wide variety of intrinsic bone lesions as well as head and neck pathology with extension into the skull base. Firstly some key points on the CT and MRI techniques used in clinical neuroradiology of the skull base region are addressed, followed by a brief discussion on what kind of information the surgeon expects to find in the radiology report. Secondly, the skull base lesions without a predilection site are reviewed, predominantly focusing on the most frequent pathology but also providing examples of some very rare tumors. Finally, an overview of the radiology of skull base tumors and pseudotumors is provided according to their common site of origin, focusing on typical clinical and imaging features.


Cranial fossa, anterior Cranial fossa, middle Cranial fossa, posterior Skull base, neoplasms Temporal bone Clivus Cerebellopontine angle Jugular foramen 

List of Abbreviations


Aneurysmal bone cyst


Antineutrophil cytoplasmic antibodies


Anterior skull base


Central giant-cell granuloma


Cerebellopontine angle


Central skull base


Cerebrospinal fluid


Computed tomography


Dynamic susceptibility contrast


Diffusion-weighted imaging


Endolymphatic sac tumors


Echoplanar imaging


Giant-cell tumor




Gradient echo


Jugular foramen


Large endolymphatic duct and sac


Langerhans cell histiocytosis


Magnetic resonance angiography


Magnetic resonance imaging


Posterior skull base


Sensorineural hearing loss


T1-weighted images


T2-weighted images


Time of flight


Turbo spin echo


  1. Badger D, Aygun N. Imaging of perineural spread in head and neck cancer. Radiol Clin N Am. 2017;55(1):139–49. Scholar
  2. Bonneville F, Savatovsky J, Chiras J. Imaging of cerebellopontine angle lesions: an update. Part 1. Enhancing extra-axial lesions. Eur Radiol. 2007a;17:2472–82. Scholar
  3. Bonneville F, Savatovsky J, Chiras J. Imaging of cerebellopontine angle lesions: an update. Part 2. Intra-axial lesions, skull base lesions that may invade the CPA region, and non-enhancing extra-axial lesions. Eur Radiol. 2007b;17:2908–20. Scholar
  4. Borges A. Skull base tumours. Part I: imaging technique, anatomy and anterior skull base tumours. Eur J Radiol. 2008a;66(3):338–47. Scholar
  5. Borges A. Skull base tumours. Part II. Central skull base tumours and intrinsic tumours of the bony skull base. Eur J Radiol. 2008b;66(3):348–62. Scholar
  6. Butman JA, Kim HJ, Baggenstos M, Ammerman JM, Dambrosia J, Patsalides A, Patronas NJ, Oldfield EH, Lonser RR. Mechanisms of morbid hearing loss associated with tumors of the endolymphatic sac in von Hippel-Lindau disease. JAMA. 2007;298(1):41–8. Scholar
  7. Casselman JW, De Jonge I, Neyt L, De Clercq C, D’Hont G. MRI in craniofacial fibrous dysplasia. Neuroradiology. 1993;35(3):234–7.CrossRefGoogle Scholar
  8. Chapman PR, Shah R, Curé JK, Bag AK. Petrous apex lesions: pictorial review. AJR Am J Roentgenol. 2011;196(3 Suppl):WS26-37. Quiz S40-3. Scholar
  9. Conley LM, Phillips CD. Imaging of the central skull base. Radiol Clin N Am. 2017;55(1):53–67. Scholar
  10. Connor SE. The skull base in the evaluation of sinonasal disease: role of computed tomography and MR imaging. Neuroimaging Clin N Am. 2015;25(4):619–51. Scholar
  11. Fernández-Latorre F, Menor-Serrano F, Alonso-Charterina S, Arenas-Jiménez J. Langerhans’ cell histiocytosis of the temporal bone in pediatric patients: imaging and follow-up. AJR Am J Roentgenol. 2000;174(1):217–21. Scholar
  12. Iida E, Anzai Y. Imaging of paranasal sinuses and anterior skull base and relevant anatomic variations. Radiol Clin N Am. 2017;55(1):31–52. Scholar
  13. Kadar AA, Hearst MJ, Collings MH, Mangano FT, Samy RN. Ewing’s sarcoma of the petrous temporal bone: case report and literature. Skull Base. 2010;20(3):213–7. Scholar
  14. Kim S, Jung DW, Pak MG, Song YJ, Bae WY. An aneurysmal bone cyst in the skull base. J Craniofac Surg. 2017;28(7):e704–6. Scholar
  15. Kimura F, Kim KS, Friedman H, Russell EJ, Breit R. MR imaging of the normal and abnormal clivus. AJR Am J Roentgenol. 1992;155:1285–91. Scholar
  16. Laigle-Donadey F, Taillibert S, Martin-Duverneuil N, Hildebrand J, Delattre JY. Skull-base metastases. J Neuro-Oncol. 2005;75(1):63–9. Scholar
  17. Na’ara S, Amit M, Gil Z, Billan S. Plasmacytoma of the skull base: a meta-analysis. J Neurol Surg B Skull Base. 2016;77(1):61–5. Scholar
  18. Pakalniskis MG, Berg AD, Policeni BA, Gentry LR, Sato Y, Moritani T, Smoker WR. The many faces of granulomatosis with polyangiitis: a review of the head and neck imaging manifestations. AJR Am J Roentgenol. 2015;205(6):W619–29. Scholar
  19. Pesce A, Acqui M, Cimatti M, Caruso R, Wierzbicki V, Raco A. Primary lymphomas of the skull base from a neurosurgical perspective: review of the literature and personal experience. J Neurol Surg A Cent Eur Neurosurg. 2017;78(1):60–6. Scholar
  20. Rubin Grandis J, Branstetter BF 4th, Yu VL. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. Lancet Infect Dis. 2004 Jan;4(1):34–9.CrossRefGoogle Scholar
  21. Saw S, Thomas N, Gleeson MJ, Bódi I, Connor S, Hortobágyi T. Giant cell tumour and central giant cell reparative granuloma of the skull: do these represent ends of a spectrum? A case report and literature review. Pathol Oncol Res. 2009;15(2):291–5. Scholar
  22. Skolnik AD, Loevner LA, Sampathu DM, Newman JG, Lee JY, Bagley LJ, Learned KO. Cranial nerve Schwannomas: diagnostic imaging approach. Radiographics. 2016;36(5):1463–77. Scholar
  23. Somers T, Casselman J, de Ceulaer G, Govaerts P, Offeciers E. Prognostic value of magnetic resonance imaging findings in hearing preservation surgery for vestibular schwannoma. Otol Neurotol. 2001;22(1):87–94. Scholar
  24. Thust SC, Yousry T. Imaging of skull base tumours. Rep Pract Oncol Radiother. 2016;21(4):304–18. Scholar
  25. VandeVyver V, Lemmerling M, De Foer B, Casselman J, Verstraete K. Arachnoid granulations of the posterior temporal bone wall: imaging appearance and differential diagnosis. AJNR Am J Neuroradiol. 2007;28(4):610–2.PubMedGoogle Scholar
  26. Vogl TJ, Bisdas S. Differential diagnosis of jugular foramen lesions. Skull Base. 2009;19(1):3–16. Scholar

Further Reading

  1. Aygun N, Miller F. Skull base imaging. Philadelphia: Elsevier; 2017.Google Scholar
  2. Chong V. Skull base imaging. 1st ed. Philadelphia: Elsevier; 2018.Google Scholar
  3. Kelly HR, Casselman JW, Cunnane MB, Curtin HD. Chapter 16 Skull base. In: Atlas SW, editor. Magnetic resonance imaging of the brain and spine. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2017.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Jan W. Casselman
    • 1
    • 2
    • 3
  • Stephanie Vanden Bossche
    • 1
    • 4
    Email author
  • Elias Pretorius
    • 5
  • Bert De Foer
    • 2
  1. 1.Department of RadiologyAZ St-Jan Brugge-OostendeBrugesBelgium
  2. 2.Department of RadiologyAZ St-AugustinusAntwerpBelgium
  3. 3.Ghent UniversityGhentBelgium
  4. 4.Department of RadiologyAZ Jan PalfijnGhentBelgium
  5. 5.Morton and Partners RadiologistsCape TownSouth Africa

Section editors and affiliations

  • Rolf Jäger
    • 1
  1. 1.University College LondonLondonUK

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