The Imaging of Large Nerve Perineural Spread

Abstract

We present a review of the imaging findings of large nerve perineural spread within the skull base. The MRI techniques and reasons for performing different sequences are discussed. A series of imaging examples illustrates the appearance of perineural tumor spread with an emphasis on the zonal staging system.

Keywords

magnetic resonance imaging - perineural spread - squamous cell carcinoma - trigeminal nerve - facial nerve

Key Points

1. The diagnosis of perineural spread on imaging is performed with high-resolution MRI techniques focused on the anatomical pathways of the cranial nerve branches rather then whole-brain and neck imaging.

2. The most important finding on MRI is asymmetrical enhancement and thickening of the involved nerve. Important ancillary findings are denervation changes in the muscles of mastication and/or facial expression.

3. The studies are ideally performed on a 3T magnet and may need to be repeated close to the time of surgery.

4. MRI is highly sensitive for the disease and can accurately stage the zonal extent of anatomical spread, thus allowing the design of an appropriate resection.

5. The optimal outcome for the patient is achieved through close collaboration between the skull base surgeon and radiologist.

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