SKULL BASE
REVIEW AND PATHOLOGY
Melissa Durand
Hartford Hospital Noon Conference
October 20, 2006
Skull Base Anatomy Review
Skull Base Boundaries Three Key Bones
• Upper surface of ethmoid bones and • Sphenoid
orbital plate of frontal bone to the
• Temporal
occiptal bone
• Occipital
Skull Base Anatomy Review
Temporal Bone
Temporal bone- petrous
portion
Sphenoid Bone
Occipital Bone
Key Fissures
• Petrosphenoidal fissure
• Petrooccipital fissure
Key Sutures
• Sphenosquamous Suture
• Occipitomastoid Suture
Skull Base Anatomy Review
Key Openings
• Foramen spinosum • Superior orbital fissure
• Foramen ovale • Inferior orbital fissure
• Foramen lacerum • Optic canal
• Foramen rotundum • Vidian canal
• Foramen magnum • Hypoglossal canal
• Foramen of vesalius • Pterygopalatine fossa
• Jugular foramen
Skull Base Anatomy Review
Skull Base Anatomy Review
Pterygopalatine
fossa
Pterygoid
canal Foramen rotundum-
higher level
f. lacerum
Foramen ovale
Foramen spinosum
Sphenoid spine-
lower level
Petro-occipital
fissure
Skull Base Anatomy Review
Foramen magnum
• Medulla oblongata
• Vertebral arteries
• Anterior/Posterior spinal
arteries
Hypoglossal canal
• CN XII
**
• Hypoglossal artery
Skull Base Anatomy Review
Jugular Foramen
• Pars nervosa: CN IX, inferior
petrosal sinus
• Pars vascularis: CN X, XI,
jugular bulb
* Carotid canal
Skull Base Anatomy Review
Foramen Spinosum
• Middle meningeal artery/vein
• CV V3, recurrent branch
• Lesser superficial petrosal nerve
Foramen Ovale
• CN V3
• Lesser petrosal nerve
• Accessory meningeal artery
• Emissary veins
Foramen of Vesalius
• Emissary vein
• Accessory meningeal artery- asc
intracranial branch
Skull Base Anatomy Review
Foramen Lacerum
• Ascending pharyngeal
artery- meningeal branch
• Nerve of pterygoid canal
Vidian Canal
• aka pterygoid canal
• Pterygopalatine fossa - foramen
lacerum
• Vidian nerve
• Vidian artery
Skull Base Anatomy Review
Foramen rotundum
• CN V2
• Artery of foramen rotundum
• Emissary veins
Skull Base Anatomy Review
Pterygopalatine Fossa
• Pterygopalatine ganglia V2
• Pterygopalatine plexus
• Communicates with:
Inferior orbital fissure
Orbital apex
Sphenopalatine foramen
Pterygomaxilary fissure
Foramen rotundum
Vidian canal
Greater/lesser palatine canals and foramina
Skull Base Anatomy Review
Cavernous Sinus
Receives: Superior opthalmic vein
Inferior opthalmic vein
Sphenoparietal sinus
Drains via: Petrosal sinuses
Basilar plexus
Pterygoid plexus
Connection: Circular sinus
Contains: CN III, IV, V1, V2, VI
Meckel’s Cave
• Posterior aspect of cavernous sinus
• Gasserian ganglion (sensory root ganglion of CN V)
Skull Base Anatomy Review
Superior Orbital Fissure
• CN III, IV, V1, VI
• Middle meningeal artery- orbital branch
• Recurrent meningeal artery
• Superior opthalmic vein
Inferior Orbital Fissure
• Infraorbital artery, vein, and nerve (V2 branch)
Optic Canal
• Optic nerve
• Opthalmic artery
Skull Base Anatomy Review
Key Openings
• Foramen spinosum • Superior orbital fissure
• Foramen ovale • Inferior orbital fissure
• Foramen lacerum • Optic canal
• Foramen rotundum • Vidian canal
• Foramen magnum • Hypoglossal canal
• Foramen of vesalius • Pterygopalatine fossa
• Jugular foramen
Skull Base Pathology
Chordoma Meningioma
Chondrosarcoma Metastases
Dermoid tumors Myeloma
Epidermoid tumors Neuroma
Glomus tumors Schwannoma
Vascular Aneurysm
Case 1
Chondrosarcoma
CT Findings:
• Irregular, destructive mass
• Centered off midline
• Petro-occipital fissure
• Calcifications, 70%; “rings/arcs”
MRI Findings:
• Low T1 signal, high T2 signal
• Enhance with contrast
• Scalloped, well circumsribed margins
Chondrosarcoma
Origin:
• Preexisting cartilaginous lesion,
synchondroses, cartilage endplates
Location:
• Paranasal sinuses, skull base, parasellar
region
• Long bones, pelvis, sternum, ribs
Clinical:
• 45 yo, median age
• Classic, mesenchymal, or dedifferentiated
Case 2
Chordoma
CT/MRI Findings:
• Expansile lytic lesion, midline
• Well delineated mass arising from bone
• Large soft tissue component
• Variable calcification
• Anteroposterior extension
• Heterogeneous enhancement on T1, T2
• Dark on T1, bright on T2
DDx:
• Chondroma
• Chondrosarcoma
• Clivus meningioma
Chordoma
Origin
• Notochord remnants
Location
• Clivus 35%
• Sacrum 50%, Vertebral bodies 15%
Clinical
• age 30-70
• Slow growing, locally aggressive
• CN VI- CN deficits
• Mets late
• Tx: surgery, radiation
Case 3
Glomus Tumor
Glomus jugulare CT/MRI Findings:
• Center: jugular foramen
• Limit: hyoid bone
• Enhance w/ contrast
• Salt and pepper appearance on MRI
• Bone erosion
Glomus Tumor
Origin:
• Chemoreceptor cells
Location:
• 10% multiple
• glomus jugulare: jugular bulb
• glomus tympanicum: cochlear promontory;
Clinical:
• Pulsatile tinnitus
• Hearing loss
• arrythmia, BP fluctuation
References
Erdem E, et al, “Comprehensive Review of Intracranial Chordoma”, Radiographics 2003; 23:
995-1009.
Grossman, R et al, Neuroradiology: The Requisites, Mosby, Philadelphia, 2003
Peretti P et al, “Chordoma”, www.emedicine.com/Radio/topic169.htm, 2005.
Pluta R et al, “Glomus Tumors”, www.emedicine.com/med/topic2994.htm, 2006.
Small J et al, “Chondrosarcoma”, http://brighamrad.harvard.edu/education/online/tcd/tcd.html.
Weissleder, R et al, Primer of Diagnostic Imaging, Mosby, Philadelphia, 2003
http://www.med.wayne.edu/diagRadiology/Anatomy_Modules/axialpages/Home_Page.html
Jennings Pond, Chester, CT
