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VOLUME 3 , ISSUE 1 ( January-April, 2011 ) > List of Articles


MRI of Lateral Skull Base Lesions

Deepak P Patkar, Rama Yanamandala, Mukesh Pardhi, Sona A Pungavkar, Vishal Gaikwad, Sudarshan Vijay Pawar

Keywords : Computed tomography (CT),Magnetic resonance imaging (MRI),Cerebellopontine angle (CPA),Internal auditory canal (IAC),Cerebrospinal fluid (CSF)

Citation Information : Patkar DP, Yanamandala R, Pardhi M, Pungavkar SA, Gaikwad V, Pawar SV. MRI of Lateral Skull Base Lesions. Int J Otorhinolaryngol Clin 2011; 3 (1):43-55.

DOI: 10.5005/jp-journals-10003-1053

Published Online: 01-08-2011

Copyright Statement:  Copyright © 2011; The Author(s).


This article reviews the role of magnetic resonance imaging (MRI) in the evaluation of lateral skull base lesions. Due to superior soft tissue resolution and multiplanar capability, MRI provides accurate information and exquisite anatomical detail. Thus, it guides the surgeon in proper preoperative planning regarding the approach of a lesion. MRI is also useful in post-treatment follow-up to assess the therapeutic response and to identify potential complications. We discuss the relevant anatomy, indications of MRI and MR pulse sequences used in the diagnosis of lesions of lateral skull base. Characteristic MRI findings of various lesions which help to arrive at a specific diagnosis as well as pitfalls of MRI which may confound the diagnosis are described. Newer MR pulse sequences enable image-guided surgery, which assist the surgeon intraoperatively, are briefly discussed. In summary, this article emphasizes the role of MRI in providing a specific answer to a clinical problem and its ability to guide the clinician for better management of patients.

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  1. Atlas of microsurgery of the lateral skull base (2nd ed). Thieme Medical Publishers 2008;13–24.
  2. Head and neck imaging (4th ed). St Louis: Mosby 2003;789–864.
  3. Head and neck imaging (4th ed). St Louis: Mosby 2003:1093–108.
  4. Imaging of the temporal bone (3rd ed). Thieme Medical Publishers 1998.
  5. Pictorial review of MRI/CT scan in congenital temporal bone anomalies in patients for cochlear implant. Indian J Radiol Imaging 2009;19:99–106.
  6. Head and neck imaging (4th ed). St Louis: Mosby 2003;1109–71.
  7. Topographical relationship of the facial and vestibulocochlear nerves in the subarachnoid space and internal auditory canal. AJNR Am J Neuroradiol 1998;19:1155–61.
  8. Head and neck imaging findings of cochlear nerve deficiency. AJNR Am J Neuroradiol 2002;23:635–43.
  9. Diameter of the cochlear nerve in deaf humans: Implications for cochlear implantation. Ann Otol Rhinol Laryngol 1992;101:988–93.
  10. The cochlear nerve in various forms of deafness. Acta Otolaryngol 1984;98:773–81.
  11. Large vestibular aqueduct and congenital sensorineural hearing loss. AJNR Am J Neuroradiol 1992;13:805–19.
  12. Radiologic manifestations of the ear in Pendred syndrome. Clin Radiol 1998;53:268–73.
  13. Constructive interference in steady state-3DFT MR imaging of the inner ear and cerebellopontine angle. AJNR Am J Neuroradiol 1993;14:47–57.
  14. Dural sinus thrombosis: Value of venous MR angiography for diagnosis and follow-up. AJR 1994;162(5):1191–98.
  15. Diagnosis of septic sinus thrombosis resonance imaging. Otolaryngol Head Neck Surg 1991;105(4):617–24.
  16. Diffusion- and perfusion-weighted MR imaging of dural sinus thrombosis. AJNR Am J Neuroradiol 2000;21(1):68–73.
  17. Head and neck imaging (4th ed). St Louis: Mosby 2003;1173–229.
  18. Chronic inflammatory disease of the middle ear cavities: Gadolinium-DTPA enhanced MR imaging. Radiology 1990;176:399–405.
  19. Cholesterol granulomas of the middle ear cavities: MR imaging. Radiology 1989;172:521–25.
  20. Giant cholesterol cysts of the petrous apex. AJNR Am J Neuroradiol 1985;6: 409–17.
  21. MR and CT in the evaluation of acquired and congenital cholesteatomas of the temporal bone. J Otolaryngol 1993;22:239–48.
  22. Segmental enhancement of the cochlear on contrast-enhanced MRI: Correlation with the frequency of hearing loss and possible sign of perilymphatic fistula and auto-immune labyrinthitis. AJNR Am J Neuroradiol 1993;14: 991–96.
  23. High signal from the otic labyrinth on unenhanced magnetic resonance imaging. AJNR Am J Neuroradiol 1992;13:1183–87.
  24. Pathology of the membranous labyrinth: Comparison of T1- and T2-weighted and gadolinium-enhanced spin-echo and 3DFT-CISS imaging. AJNR Am J Neuroradiol 1993;14(1):59–69.
  25. MR of the inner ear in patients with Cogan syndrome. AJNR Am J Neuroradiol 1994;15(1):131–38.
  26. Necrotizing (malignant) external otitis: Prospective comparison of CT and MR imaging in diagnosis and follow-up. Radiology 1995;196(2):499–504.
  27. Cranial osteomyelitis: Diagnosis and follow-up with In-111 white blood cell and Tc-99m methylene diphosphonate bone SPECT, CT and MR imaging. Radiology 1995;196(3):779–88.
  28. Head and neck imaging (4th ed). St Louis: Mosby 2003;1230–44.
  29. Contrastenhanced MRI of the facial nerve in patients with post-traumatic peripheral facial nerve palsy. AJNR Am J Neuroradiol 1997;18:1115–22.
  30. Magnetic resonance imaging in temporal bone fractures. Neuroradiology 1987;29:246–51.
  31. Spontaneous labyrinthine hemorrhage in sickle cell disease. AJNR Am J Neuroradiol 1998;19:1437–40.
  32. Deafness after bilateral midbrain contusion: A correlation of magnetic resonance imaging with auditory brainstem evoked responses. Neurosurgery 1991;29:1101.
  33. Clinical imaging of the cerebellopontine angle. Berlin: Springer-Verlag 1986.
  34. Pathophysiology of acoustic tumors. Diagnosis. Baltimore: University Park Press 1979:1.
  35. Pre- and postoperative management of the acoustic tumor patient. Management. Baltimore: University Park Press 1979:2.
  36. Clinical manifestations and audiologic diagnosis of acoustic neuromas. Otolaryngol Clin North Am 1992;25(3):521–51.
  37. MRI screening for acoustic neuroma: A comparison of fast spin echo and contrast enhanced imaging in 1233 patients. Br J Radiol 2000;73: 242–47.
  38. Prognostic value of magnetic resonance imaging findings in hearing preservation surgery for vestibular schwannoma. Otol Neurotol 2001;22(1):87–94.
  39. Cochlear fossa enhancement at MR evaluation of vestibular schwannoma: Correlation with success at hearing-preservation surgery. Radiology 2000;215(2):458–62.
  40. Gas-CT cisternography for detection of small acoustic nerve tumors. Radiology 1984;150(2):403–07.
  41. CT of meningiomas on the posterior surface of the petrous bone. Neuroradiology 1981;22(3):111–21.
  42. Cystic acoustic schwannomas: MR characteristics. AJNR 1993;14(5):1241–47.
  43. MR imaging of cerebellopontine angle and internal auditory canal lesions at 1.5 T. AJR 1988;150(6):1371–81.
  44. Acoustic neuromas: Gd-DTPA enhancement in MR imaging. Radiology 1986;158(2):447–51.
  45. Rule out eighth nerve tumor: Contrast-enhanced T1-weighted or high-resolution T2-weighted MR. AJNR 1997;18(10):1834–38.
  46. Meningiomas: MR and histopathologic features. Radiology 1989;170(3 Pt 1):857–62.
  47. Cerebellopontine angle-petromastoid mass lesions: Comparative study of diagnosis with MR imaging and CT. Radiology 1987;162(2):513–20.
  48. Prominent dural enhancement adjacent to nonmeningiomatous malignant lesions on contrast-enhanced MR images. AJNR Am J Neuroradiol 1991;12(4):761–64.
  49. Epidermoid cysts of the posterior fossa. J Neurosurg 1985;62(2):214–19.
  50. Diffusion-weighted MR imaging of the brain: Value of differentiating between extra-axial cysts and epidermoid tumors. AJR 1990;155(5):1059–65; discussion 1066-68.
  51. Combining steady-state constructive interference and diffusion-weighted magnetic resonance imaging in the surgical treatment of epidermoid tumors. Neurosurg Rev 1999;22(2-3):159–62.
  52. Epidermoid or arachnoid cyst: CISS, FLAIR and diffusion images as solution of the diagnostic dilemma. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2001;173(1):77–78.
  53. The Meckel cave: Computed tomographic study. Part I: Normal anatomy; Part II: Pathology. Radiology 1984;152(2):425–33.
  54. Reversible compression neuropathy of the eighth cranial nerve from a large jugular foramen schwannoma. Arch Otolaryngol 1979;105(9):555–60.
  55. Vascular contact with the fifth cranial nerve at the pons in patients with trigeminal neuralgia: Detection with 3D FISP imaging. AJR 1994;163(6):1447–52.
  56. Imaging the cranial nerves: Part II: Primary and secondary neoplastic conditions and neurovascular conflicts. Eur Radiol 2007;17:2332–44.
  57. The temporal bone contemporary diagnostic dilemmas. Radiol Clin North Am 1998;36:819–53.
  58. Role of magnetic resonance imaging and magnetic resonance angiography in patients with hemifacial spasm. Ann Acad Med Singapore 1999;28(2):169–73.
  59. Preoperative assessment of trigeminal neuralgia and hemifacial spasm using constructive interference in steady state three-dimensional fourier transformation magnetic resonance imaging. Neurol Med Chir (Tokyo) 2000;40(11):545–55; discussion 555-56.
  60. Giant intracranial aneurysms: MR imaging. Radiology 1987;163(2):431–35.
  61. Intratemporal vascular tumors: Detection with CT and MR imaging. Radiology 1989;171(2):445–48.
  62. High-resolution CT of the jugular foramen: Anatomy and vascular variants and anomalies. Radiology 1984;150(3):743–47.
  63. MR imaging of paragangliomas. AJR 1987;148(1):201–04.
  64. Skull base tumors: Gadodiamide injection—enhanced MR imaging—drop-out effect in the early enhancement pattern of paragangliomas versus different tumors. Radiology 1993;188(2):339–46.
  65. Irradiated paragangliomas of the head and neck: CT and MR appearance. AJNR Am J Neuroradiol 1994;15(2):357–63.
  66. Slow flow phenomena in magnetic resonance imaging of the jugular bulb masquerading as skull base neoplasms. Am J Otology 1996;17:648–52.
  67. Head and neck Imaging (4th ed). St Louis: Mosby 2003;1361–74.
  68. MR imaging and MR angiography in the evaluation of pulsatile tinnitus. AJNR Am J Neuroradiol 1994;15:879–89.
  69. Suspected dural arteriovenous fistula: Results with screening MR angiography in seven patients. Radiology 1992;183:265–71.
  70. Intracranial meningiomas: High-field MR imaging. Radiology 1986; 161(2):369–75.
  71. Head and neck Imaging (4th ed). St Louis: Mosby 2003;1275–360.
  72. Imaging of the skull base. Radiol Clin North Am 1998;36(5):801–17.
  73. Giant cholesterol cysts of the petrous apex: Radiologic features. AJNR Am J Neuroradiol 1985;6(3):409–13.
  74. Cholesterol granuloma of the petrous apex: MR and CT evaluation. AJNR Am J Neuroradiol 1988;9(6):1205–14.
  75. Multiple intrapetrous aneurysms of the internal carotid artery. AJNR Am J Neuroradiol 1983;4(5): 1119–21.
  76. Partially thrombosed giant intracranial aneurysms: Correlation of MR and pathologic findings. Radiology 1987;162:111–14.
  77. St Louis: Mosby-Yearbook 1994.
  78. Hearing II: The retrocochlear auditory pathway. AJNR Am J Neuroradiol 1996;17:1479–81.
  79. Enhancement along the normal facial nerve and facial canal: MR imaging and anatomic correlation. Radiology 1992;183:384–91.
  80. Facial nerve palsy: Evaluation by contrast-enhanced MR imaging. Clin Radiol 2001;56:926–32.
  81. Facial nerve palsy in Lyme disease evaluation of clinical diagnostic criteria. Am J Otol 1997;18:257–61.
  82. Imaging of the temporal bone. Magn Reson Imaging Clin N Am 2002;10:573–613.
  83. Facial palsy from temporal bone lesions. Ann Acad Med Singapore 2005;34:322–29.
  84. Neuroimaging of meningeal disease. Semin Ultrasound CT MR 1994;15:466–98.
  85. Intratemporal vascular tumors: Detection with CT and MR imaging. Radiology 1989;171(2):445–48.
  86. Management of complications from 820 temporal bone fractures. Am J Otol 1997;18:188–97.
  87. Contrast-enhancement MR of the facial nerve in patients with post-traumatic peripheral facial nerve palsy. AJNR Am J Neuroradiol 1997;18:1115–25.
  88. Brain herniation into the middle ear cavity: MR imaging. Neuroradiology 1989;31: 184–86.
  89. Metallic otologic implants: In vitro assessment of ferromagnetism at 1.5 T. AJNR Am J Neuroradiol 1991;12(2):279–81.
  90. ; 2011. Available at: .
  91. Gadolinium-enhanced MR of the postoperative internal auditory canal following acoustic neuroma resection via a middle cranial fossa approach. AJNR Am J Neuroradiol 1992;13:197–200.
  92. The evolving appearance of structures in the internal auditory canal after removal of an acoustic neuroma. AJNR Am J Neuroradiol 1997;18:313–23.
  93. Application of neuronavigation in neurosurgery at King Hussein Medical Center, Jordan. Rawal Medical Journal Jan-Jul 2010;35(1):91–94.
  94. Intraoperative magnetic resonance imaging for skull base surgery. Laryngoscope 2001;111: 1570–75.
  95. Image-guided procedures of the skull base. Otolaryngol Clin N Am 2005;38:483–90.
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