Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Nov 2021
ReviewNeurosurgical Approaches to the Skull Base: A Guide for the Radiologist.
Skull base surgery relies on the assessment of detailed neuroimaging studies to assist with surgical planning. We review typical neuroimaging features associated with common neurosurgical skull base approaches, highlighting relevant imaging anatomy and pertinent postoperative imaging appearances.
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The petrous apex may be affected by a range of lesions, commonly encountered as incidental and asymptomatic findings on imaging performed for other clinical reasons. Symptoms associated with petrous apex lesions commonly relate to mass effect and/or direct involvement of closely adjacent structures. Petrous apex lesions are optimally assessed using a combination of high-resolution CT and MRI of the skull base. Management of petrous apex lesions varies widely, reflecting the range of possible pathologies, with imaging playing a key role, including lesion characterization, surveillance, surgical planning, and oncological contouring.
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Neuroimaging Clin. N. Am. · Nov 2021
ReviewAnterior and Central Skull Base Tumors: Key Points for the Radiologist to Analyze Prior to Endoscopic Approaches.
Initially developed as a minimally invasive technique to approach inflammatory conditions, transnasal endoscopic surgery has progressively expanded its anatomic targets and clinical indications. Consequently, numerous surgical approaches to the anterior and central skull base were developed, referred to as extended endonasal approaches (EEA). The intrinsic advantage of EEA is the exploitation of a natural corridor provided by sinonasal airspaces, with no need for skin incision and osteotomy and limited soft tissue damage. In this context, imaging plays essential role, demonstrating the relevant anatomic relationships of the lesion, the proper surgical corridor, the anatomic variants that may increase the surgical risk.
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Neurodiagnostic and neurointerventional radiology (NIR) play a central role in the diagnosis and treatment of skull base disorders. Noninvasive imaging modalities, including computed tomography and magnetic resonance imaging, are important in lesion localization, evaluation of lesion extent, and diagnosis, but cannot always be definitive. ⋯ NIR plays an important role in the treatment of vascular disorders of the skull base. This article summarizes the imaging evaluation and interventional therapies pertinent to the skull base.
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Skull base infections are uncommon but can be life threatening without timely recognition. Imaging plays a crucial role because symptoms can be vague and nonlocalizing. ⋯ Multiparametric magnetic resonance (MR) and high-resolution CT are the mainstays for establishing a diagnosis and estimating disease extent, with MR being superior in ascertaining marrow and soft tissue involvement. Monitoring treatment response, of which imaging is a fundamental part, is challenging, with emerging promising imaging tools.