Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Feb 2019
ReviewImaging of Temporal Bone Trauma: A Clinicoradiologic Perspective.
Imaging plays an important role in the evaluation of temporal bone trauma. Certain imaging findings can significantly change patient management or change surgical approach. Precise knowledge of clinical or surgical management can guide the review of imaging to detect these key findings. This article reviews the clinical and imaging findings as well as management of complications from temporal bone trauma, including hearing loss, vertigo, perilymphatic fistula, cerebrospinal fluid leak, facial nerve injury and vascular injury.
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Although not all patients with tinnitus require imaging, patients with tinnitus and asymmetric hearing loss, additional neurologic findings, or pulsatile tinnitus should be evaluated with an appropriately tailored imaging study. Choice of imaging study should be guided by type of hearing loss and additional physical examination findings, such as middle ear lesion, presence of carotid bruit, or pulsatile tinnitus extinguished by jugular compression.
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Visualization of the morphologic substrate of Ménière disease, the endolymphatic hydrops, can be performed using noncontrast or contrast-enhanced MR imaging techniques. Noncontrast MR imaging uses a heavily T2-weighted sequence; however, its reproducibility remains to be confirmed. ⋯ The latter technique is most frequently used and is able to detect and grade Ménière disease. It is a reliable technique with a high diagnostic accuracy, enabling visualization of endolymphatic hydrops.
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Neuroimaging Clin. N. Am. · Feb 2019
ReviewCommon Otologic Surgical Procedures: Clinical Decision-Making Pearls and the Role of Imaging.
Neuro-otologists rely on the expertise and judgment of a skilled neuroradiologist to identify radiographic abnormalities in the complicated regional anatomy of the temporal bone and middle and posterior fossa, and more importantly, to alert the surgeon to potential operative pitfalls. This article highlights some of the common otologic surgical procedures that stress this important dynamic. The surgical perspective on quick and effective clinical decision-making pearls to keep in mind during a thorough radiographic analysis of the ear and lateral skull base is presented.