#Skull base radiology FOR #RADIATION ONCOLOGISTS
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This document provides an overview of skull base radiology for radiation oncologists. It discusses the complex anatomy of the skull base area and lists the important structures and contents, including bones, foramina, fissures, canals, ganglia, nerves, vessels, and more. It highlights key areas like the anterior, middle, and posterior cranial fossae and provides labeled images to illustrate important structures like foramina, canals, and the origins and paths of cranial nerves. Slice-by-slice views from different skull base levels are also included to demonstrate the anatomy in detail.
![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