DAVID SUTTON PICTURES THE SKULL ONLY FOR STUDY SHARING

1. 53David Sutton

2. DAVID SUTTON PICTURES
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig. 53.1 The four standard skull proiections:
(A) lateral; (B) PA; ( C) Towne's; (D) basal.

4. • Fig. 53.2 (A) X-ray film of
skull taken in standard
lateral projection.
• (B) Diagram to illustrate the
standard lateral view. 1 =
coronal suture;
• 2 = meningeal vascular
marking, anterior branch; 3
= anterior border of
• middle fossa; 4 = lambdoid
suture; 5 = dorsum sellae; 6
= clivus; 7 = lateral
• sinus; 8 = squamoparietal
suture; 9 = external
auditory meatus.

5. • Fig. 53.3 (A) X-ray film taken in standard AP projection. (B) Diagram to illustrate (A) 1
- crista galli; 2 = lesser sphenoidal wing; 3 = zygomaticofrontal suture; 4 superior
orbital fissure; 5 nasal septum; 6 innominate line formed by inner wall of temporal
fossa; 7 = superior margin of petrous ridge; 8 = maxillary antrum.

6. • Fig. 53.4 (A) X-ray film taken in standard Towne's projection. (B)
Diagram to illustrate (A) 1 = lateral sinus; 2 = foramen magnum; 3
= dorsum sellae; 4 = internal auditory meatus; 5 = acuate
eminence; 6 = superior semicircular canal; 7 = lambdoid suture.

7. • Fig. 53.5 (A) X-ray film taken in standard basal view. (B) Diagram
to illustrate (A) 1 = greater sphenoidal wing; 2 = sphenoidal sinus;
3 = foramen ovale; 4 = foramen spinosum; 5 = foramen lacerum
medium; 6 = foramen magnum; 7 = internal auditory meatus.

8. • Fig. 53.6 Structures
seen in optic foramen
view. a = optic
foramen; b = frontal
sinuses; c = roof of
orbit; d = ethmoid
sinuses. See also Fig.
53.54.

9. • Fig. 53.7 Structures seen in oblique
(Stockholm C) view of petrous bone. a =
internal auditory meatus; b = internal ear and
semicircular canals; c = mastoid air cells; d =
temporomandibular joint.

10. • Fig. 53.8 Internal auditory meatuses as seen
in the Towne's view. a = dorsum sellae; b =
internal auditory meatus; c = internal ear; d =
mastoid air cells.

11. • Fig. 53.9 Internal auditory meatus as seen in
transorbital view. a = internal auditory
meatus; b = internal ear and semicircular
canals; c = frontal sinuses; d = ethmoid
sinuses.

12. • Fig. 53.10 Two vascular markings on the outer
surface of the skull which may resemble
fractures and are due to: (1) the middle temporal
artery; (2) the supraorbital artery. The meningeal
vascular markings are shown by dotted lines.
(After Schunk and Maryana 1960).

13. • Fig. 53.11 (A) Diagram of normal sella. a =
anterior clinoids; b = posterior clinoids; c =
cortex or 'lamina dura' of dorsum and floor of
sella. (B) J-shaped sella. d = sulcus
chiasmaticus.

14. • Fig. 53.12 Neonate skull. Note the wide
fontanels and sutures.

15. • Fig. 53.13 (A) Heavily clacified Pineal Gland
(arrow). (B) Calcification in the habeneular
commissure. (arrow)

16. • Fig. 53.14 Calcified choroid plexuses. (A)
Lateral view. (B) Towne's view.

17. • Heavily calcified Falx.

18. Fig. 53.16 Neonatal skull showing features of note.
(A Frontal view. 1 = coronal suture; 2 = lambdoid
suture; 3 = sagittal suture; 4 = metopic suture; 5 =
anterior fontanel; 6 = posterior fontanel. (B)
Lateral view. 1 = coronal suture; 2 = lambdoid
suture; 3 = mendosal suture; 4 = anterior
fontanel; 5 = posterior fontanel. (C) Towne's view.
1 = interparietal bone; 2 = supraoccipital bone; 3
= exoccipital bone; 4 = foramen magnum; 5 =
posterior fontanel; 6 = mendosal suture; 7 =
synchondrosis between supraoccipital and
exoccipital.

19. • Fig. 53.17
Oxycephaly due to
premature fusion
of the coronal
sutures. Note
increased
convolutional
markings.

20. • Fig. 53.18 Hand of the
same patient as Fig.
53.1 7, showing
syndactyly. The
combination of
oxycephaly and
syndactyly comprises
Apert's syndrome.

21. • Fig. 53.19 Lacunar skull in an infant. Note the
wide sutures.

22. • Fig. 53.20 (A) Chamberlain's line (arrow). (B) Normal
relationship between digastric grooves and atlanto-
occipital joint. The distance between the arrowheads
normally measures 1.1 cm (± 0.4 cm).

23. • Fig. 53.21 (A) Lateral and (B) PA films of child with
raised intracranial pressure and marked suture
diastasis involving the coronal and sagittal
sutures.

24. • Fig. 53.22 Diagram of the sellar changes in
raised intracranial pressure in the adult. (a-f)
show progressive changes from slight (b) to
gross (f).

25. • Fig. 53.23 Advanced changes due to chronic
raised pressure. The dorsum sellae has
become ill defined. The anterior clinoids are
also affected and the floor of sella is indistinct.

26. • Fig. 53.24 Displacement of the calcified
pineal by a right hemisphere tumour. The
displacement measures 5 mm on the original
film. T = midpoint; .f = pineal.

27. • Fig. 53.25 Mottled
calcification in a
slow-growing
frontal glioma.

28. • Fig. 53.26 Sinuous
calcification in a
frontal glioma.
Note the evidence
of raised pressure
in the sella, which
shows loss of
definition of its
surrounding cortex
(arrowhead).

29. • Fig. 53.27 Hazy
amorphous
calcification in a
glioma of the
occipital lobe.

30. • Fig. 53.28 Irregular calcification in a
craniopharyngioma (arrowheads). Note the
bowed shape of dorsum sellae.

31. • Fig. 53.29 Heavily
calcified
craniopharyngioma
growing upward
and forward from
the sella.

32. • Fig. 53.30
Calcified
craniopharyngiom
a. The
calcification in the
upper part
appears to be
outlining a cyst
(arrowhead) and
the tumour is
actually
encroaching on
the sella.

33. • Fig. 53.31 (A,B)
Heavily calcified
parasagittal
meningioma. The
site and type of
calcification, which
outlines the whole
tumour, are
characteristic.

34. • Fig. 53.32 Calcified meningioma. Calcification is
less typical but again the site, with the base of
the tumour against the vault in the parasagittal
region, is characteristic. The presence of a local
hyperostosis and prominent frontal vascular
markings also help to confirm the diagnosis.

35. • Fig. 53.33 Calcified dermoid in the posterior
fossa. Note ring calcification (arrowheads).

36. • Fig. 53.34 Lipoma of
corpus callosum,
showing 'bracket'
calcification.

37. • Fig. 53.35 Calcification
(arrowhead) in a
chordoma growing
from the clivus

38. • Fig. 53.36 Large calcified aneurysm of the anterior
communicating artery (arrowheads). The lesion is
unusually large, but the marginal calcification is typical.
Most calcified aneurysms are under 1 cm in diameter. (A)
Lateral view. (B) PA view.

39. • Fig. 53.37 Multiple flecks and specks of
calcification in an angiomatous malformation
(arrow).

40. • Fig. 53.38 Flecks of calcification associated
with a calcified ring shadow in an angioma
(arrowheads).

41. • Fig. 53.39 Calcification in the margins of
chronic bilateral subdural haematomas
(arrowheads).

42. • Fig. 53.40 Unusually heavy calcification
outlining the whole of the carotid siphon and
shown to be bilateral in the frontal projection.

43. • Fig. 53.41 Calcified basal exudate above the
sella in a patient with healed tuberculous
meningitis (arrowheads).

44. • Fig. 53.42 Toxoplasmosis. Note characteristic
multiple flecks of calcification.

45. • Fig. 53.43 Cysticercosis. There are multiple
small calcified lesions 2-3 mm in diameter
(arrowheads).

46. • Fig. 53.44 Heavy calcification in the basal
ganglia and dentate nuclei. (A) Lateral View.
(B) Townes View.

47. • Fig. 53.45 Tuberous sclerosis. There are nodules
of calcification in the posterior fossa, in the
frontal region, and in the parietal region. The last
is nearly superimposed on the pineal.

48. • Fig. 53.46 Calcified occipital cortex in Sturge-
Weber syndrome.

49. • Fig. 53.47 Enlarged meningeal and diploic vascular
markings associated with a parasagittal meningioma.
There is also a localised hyperostosis (arrowheads).
(A) Lateral view. (B) PA view.

50. • Fig. 53.48 Bilateral hypertrophy of the middle
meningeal vascular markings in a patient with
a large angiomatous malformation.

51. • Fig. 53.49 Nasopharyngeal carcinoma
producing erosion of the floor of the middle
fossa on the left (arrows).

52. • Fig. 53.51 Multiple lytic deposits in the skull
vault in a patient with carcinoma of the
breast.

53. • Fig. 53.52 (A) Pituitary adenoma, showing ballooning of the sella
and backward bulging of the dorsum. (B) Pituitary adenoma
showing ballooning of the sella with undercutting of the anterior
clinoids, backward bowing and thinning of the dorsum (arrowhead).

54. • Fig. 53.53
Craniopharyngioma
without
calcification. The
shape of the sella,
which is elongated,
and the dorsum,
which is slightly
bowed forward, are
suggestive of the
cause.

55. • Fig. 53.54 Glioma of the left optic nerve. The
left optic foramen (arrow) is markedly
expanded compared with the normal right.

56. • Fig 53.55 Extensive erosion of the skull vault
along the sagittal and coronal sutures. This
was due to unrecognised chronic
osteomyelitis following a minor scalp wound
which was sutured.

57. • Fig. 53.56 Parietal thinning. The Towne's or PA
projections show clearly that the external table and
diploe are affected while the internal table remains
(arrowheads).

58. • Fig. 53.57 Small parasagittal hyperostosis in
the parietal region associated with a
meningioma (arrowhead). Note the prominent
vascular channels leading to the lesion.

59. • Fig. 53.58 Meningioma growing through the
skull vault. Note the sunray spiculation and
the enlarged vascular channels of the skull
vault. (A) Lateral view.

60. • Fig. 53.59 Transverse linear fracture of the
skull vault showing as a translucency ( ).
There is also a vertical fracture showing as an
increased density ( ).

61. • Fig. 53.60 Brow-up
film showing
pneumocephalus
following frontal
fractures. Note the
air-fluid level, best
seen in brow-up
lateral films.