#Skull base radiology FOR #RADIATION ONCOLOGISTS
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Skull base radiology FOR RADIATION ONCOLOGISTS
![Radiology for Radiation Oncologists
Skull base radiology
Dr Kanhu Charan Patro
MD,DNB[RADIATION ONCOLOGY],MBA,CEPC,PDCR
HOD, Radiation Oncology
MGCHRI, Visakhapatnam, INDIA
1](https://image.slidesharecdn.com/skullbaseradiology-200709161512/85/skull-base-radiology-for-radiation-oncologists-1-320.jpg)
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#Skull base radiology FOR #RADIATION ONCOLOGISTS
- 1. Radiology for Radiation Oncologists Skull base radiology Dr Kanhu Charan Patro MD,DNB[RADIATION ONCOLOGY],MBA,CEPC,PDCR HOD, Radiation Oncology MGCHRI, Visakhapatnam, INDIA 1
- 2. 2
- 3. Why a radiation oncologist need it? • Some head and neck cancers having perineural spread • Para nasal sinus • Nasopharynx • Salivary gland • Buccal mucosa • Complex nature of skull base area • Some tumors like schwannoma arise from cranial nerves • Some functional issues like trigeminal neuralgia need SRS 3
- 5. Buccal mucosa with intracranial extension 5
- 6. Parotid with intracranial spread 6
- 7. Nasopharynx with sphenopalatine foramen (SPf) left 7
- 8. Maxilla with Pterygo palatine fossa invasion 8
- 9. 9
- 10. Normal skull base • Extend – root of nose anteriorly to the superior nuchal line posteriorly 10
- 11. Structures and contents • BONES • Fossa • Foramen • Fissure • Canal • CONTENTS • Ganglion • Nerve • Vessel • Vein • Artery 11
- 12. What to see? • FORAMINA • SUTURES • CANALS • FISSURES • FOSSES 12
- 13. Normal skull base • 5 bones: – Frontal – Ethmoid – Sphenoid – Temporal – Occipital 13
- 14. 14
- 15. Two ridges Sphenoid ridge 15
- 16. 3 fossae 16
- 17. Ethmoid bone • Cribriform plate is perforated by approx 20 holes on each side of the crista galli • Nerve fibres of olfactory nerve (CN I) pass from nasal mucosa to olfactory bulb • Crista galli serves as the anchor for anterior margin of the falx cerebri 17
- 18. Normal skull base • Most important part: – Basisphenoid (anterior aspect of sella) – Basiocciput (posterior lip of the foramen magnum) 18
- 19. Sphenoid bone • 3 compartments: – Basisphenoid: • Dorsum sella, posterior clinoids, sella turcica, tuberculum sella, sphenoid sinus • Fused to clivus in adult – Greater wing of sphenoid • Medial two-thirds and anterior wall of the middle cranialfossa floor – Lesser wing of sphenoid • Medial and superior aspects of the anterior wall of the middle cranial fossa and the anterior clinoids • Superior and medial edgesof the superior orbital fissure 19
- 20. Anterior view 20
- 21. Superior view 21
- 23. 23
- 24. 24
- 25. 25
- 26. 26
- 27. 27
- 28. Anterior fossa foramina • Foramen cecum • ANTERIOR ETHMOIDAL FORAMEN • Foramen cribriform • POSTERIOR ETHMOIDAL FORAMEN • ORBITO MENINGEAL FORAMEN 28
- 29. Foramen cecum 29
- 30. Foramen cecum Content • Emissary veins to superior sagittal sinus from the upper part of the nose 30
- 31. Cribriform foramen Content • Olfactory nerve bundles (I) 31
- 32. Anterior and posterior ethmoidal foramen Content • Anterior ethmoidal foramen • Anterior ethmoidal artery • Anterior ethmoidal vein • Posterior ethmoidal foramen • Posterior ethmoidal artery • Posterior ethmoidal vein 32
- 33. Supraorbital foramen Content • Supraorbital artery supraorbital vein • Supraorbital nerve 33
- 34. Middle cranial fossa foramina • Superior orbital fissure • Inferior orbital fissure • Optic canal • Foramen rotundum • Foramen ovale • Foramen lacerum • Foramen spinosum 34
- 35. 35
- 36. Superior orbital fissure Content • Superior ophthalmic vein • Inferior ophthalmic veins • Oculomotor nerve (III) • Trochlear nerve (IV) lacrimal, frontal • Nasociliary branches of ophthalmic nerve (V1) • Abducent nerve (VI) 36
- 37. Inferior orbital fissure Content • Inferior ophthalmic veins infraorbital artery infraorbital vein, • Tributary of pterygoid plexus • Zygomatic nerve and infraorbital nerve of maxillary nerve (V2) • Orbital branches of pterygopalatine ganglion 37
- 38. Optic canal Content • Ophthalmic artery • Optic nerve (II) 38
- 39. Foramen rotundum Content • Maxillary nerve (V2) 39
- 40. Foramen ovale Content • Accessory meningeal artery, • Emissary vein connecting cavernous sinus with pterygoid plexus • Mandibular nerve (V3) • Lesser petrosal nerve 40
- 41. Foramen lacerum Content • Artery of pterygoid canal, • Meningeal branch of ascending pharyngeal artery, • Emissary vein • Nerve of pterygoid canal through its anterior wall 41
- 42. Foramen spinosum Content • Middle meningeal artery • Meningeal branch of the mandibular nerve (V3) 42
- 43. Posterior cranial fossa foramina • Internal auditory meatus • Jugular Foramen • Hypoglossal canal • Foramen magnum 43
- 44. Internal auditory meatus Content • Labyrinthine artery • Facial nerve (VII), • Vestibulocochlear nerve (VIII) 44
- 45. Jugular foramen Content • Internal jugular vein, • Inferior petrosal sinus, • Sigmoid sinus • Glossopharyngeal nerve (IX), • Vagus nerve (X), • Accessory nerve (XI) 45
- 46. Hypoglossal canal Content • Hypoglossal nerve 46
- 47. Foramen magnum Content 1. Anterior and posterior spinal arteries, vertebral arteries 2. Lowest part of medulla oblongata, three meninges, ascending spinal fibers of accessory nerve (XI) 47
- 48. OVALE OVAL MAGNUM MAGNA ROTUNDUM ROUND LACERUM LARGE SPINOSUM SMALL SUPERIOR ORBITAL FISSURE SUPERIOR INFERIOR ORBITAL FISSURE INFERIOR OPTIC CANAL CANAL VIDIAN CANAL CANAL SOFTWARERadiAnt DICOM Viewer (64-bit).lnk 48
- 49. Pterygomaxillary area • Pterygopalatine fossa • Pterygomaxillary fissure • Sphenopalatine foramen • Sphenopalatine ganglion 49
- 50. 50
- 51. 51
- 52. 52
- 59. 59
- 60. 60
- 63. Sphenopalatine foramen opens to nasal cavity 63
- 64. Vidian canal 64
- 66. Inferior opthalmic vein Drains via: Sphenoparietal sinus Petrosal sinuses Basilar plexus Connection: Contains: Pterygoid plexus Circular sinus CN III, IV, V1, V2, VI Skull Base Anatomy Cavernous Sinus Receives: Superior opthalmic vein Meckel’s Cave • Posterior aspect of cavernous sinus • Gasserian ganglion (sensory root ganglion of CN V) 66
- 67. Origin of cranial nerves 1. Magnetic resonance imaging (MRI) is the gold standard technique in the study of the cranial nerves 2. Steady-state free procession (SSFP) images are the best sequences for the visualization of the cisternal segments showing dark cranial nerves against a background of bright cerebrospinal fluid (CSF) 3. Computed tomography (CT) can be useful to evaluate intraosseous segments of cranial nerves, skull base foramina, and bony traumatic lesions https://mrimaster.com/anatomy%20brain%20cranial%20nerves .html for cranial nerve 67
- 74. 7th and 8th cranial nerve 74
- 75. 9th ,10th and 11th cranial nerve 75
- 76. 12th cranial nerve 76 softwareRadiAnt DICOM Viewer (32-bit).lnk
- 77. SLICE BY SLICE DOWN TO UP 77
- 78. LEVEL-1 78
- 88. LEVEL-2 88
- 90. MASTOID 90
- 97. LEVEL-3 97
- 103. PTERYGOID PLATES 103
- 106. STYLOID PROCESS 106
- 107. ZYGOMATIC BONE 107
- 108. Articular tubercle (at anterior root of zygomatic arch) 108
- 109. LEVEL-4 109
- 113. Pterygoid plates 113
- 116. Occipital bone (squamous part) 116
- 119. Sphenoid spine 119
- 122. Zygomatic arch 122
- 123. Zygomaticofacial foramen / canal 123
- 124. LEVEL-5 124
- 125. Foramen ovale 125
- 126. Foramen spinosum 126
- 127. Hyoglossal canal 127
- 129. Occipital bone (squamous portion) 129
- 136. Temporal bone, tympanic and petrous portions 136
- 138. LEVEL-6 138
- 139. Carotid canal 139
- 141. FORAMEN OVALE 141
- 142. FORAMEN SPINOSUM 142
- 143. FORAMEN LACERUM 143
- 144. Sphenoid bone, greater wing 144
- 147. JUGULAR FORAMEN 147
- 148. Occipital bone, squamous part 148
- 157. PETROUS PART OF TEMPORAL BONE 157
- 158. . Temporal bone, squamous part 158
- 159. Temporal bone, tympanic part 159
- 161. LEVEL-7 161
- 162. CAROTID CANAL 162
- 163. CLIVUS 163
- 164. Foramen lacerum 164
- 165. FORAMEN OVALE 165
- 166. FORAMEN SPINOSUM 166
- 167. Jugular foramen becoming sigmoid sinus 167
- 169. Jugular tubercle of occipital bone (roof of hypoglossal canal) 169
- 170. Occipital bone, squamous part 170
- 175. BODY SPHENOID 175
- 179. PETROUS TEMPORAL 179
- 180. TYMPANIC PART OF TEMPORAL 180
- 181. SQUMOUS TEMPORAL 181
- 182. LEVEL-8 182
- 183. CAROTID CANAL 183
- 184. FORAMEN ROTUNDUM 184
- 185. JUGULAR TUBERCULE OF OCCIPITAL BONE 185
- 187. MIDDLE EAR 187
- 188. SQUOMOS OCCIPUT 188
- 191. SPHENOID BODY 191
- 195. PETROUS TEMPORAL 195
- 199. LEVEL-9 199
- 200. BASAL TURN OF COCHLEA 200
- 201. Groove in body of sphenoid bone for internal carotid artery 201
- 202. MIDDLE EAR 202
- 203. SQUOMOS OCCIPUT 203
- 205. Space connecting superior and inferior orbital fissures 205
- 206. BODY SPHENOID 206
- 210. TEMPORAL BONE, SQUAMOUS PART 210
- 211. LEVEL-10 211
- 212. COCHLEA 212
- 214. MIDDLE EAR WITH MALLEUS AND INCUS 214
- 215. SQUAMO OCCIPUT 215
- 217. BODY SPHENOID 217
- 219. Space connecting superior and inferior orbital fissures 219
- 221. PETROUS TEMPORAL 221
- 222. LEVEL-11 222
- 224. Middle ear with malleus and incus 224
- 227. BODY SPHENOID 227
- 230. PETROUS TEMPORAL 230
- 232. VESTIBULE WITH SEMICIRCULAR CANAL 232
- 233. LEVEL-12 233
- 234. SQUAMO- OCCIPITO 234
- 237. BODY SPHENOID 237
- 240. PETROUS TEMPORAL 240