Navigating the Skull Base - Imaging Pearls and Pitfalls

Objective: Imaging of the skull base can be challenging due to complex anatomy, juxtaposition of critical structures, and the spectrum of primary and distant lesions that can affect this confined space. Keen understanding of skull base anatomy and important anatomic relationships, in addition to skull base disease pathology, are essential to providing surgeons salient preoperative details. The objective of this review is to describe important pearls and pitfalls unique to skull base imaging in the preoperative arena.

Method: Single institution, retrospective review of medical records, cross-sectional imaging, and pathology reports in patients with known skull base lesions from 2007 - 2016.

Results: A brief overview of key skull base anatomy will be reviewed, along with an image-rich presentation of multiple skull base lesions and pathology, which highlight important imaging features. The spectrum of pathology will include primary skull base tumors, perineural spread, metastasis, and secondary concomitant pathologies.

Conclusion: Given the complexity of the anatomy and the diversity of the pathology involving the skull base, imaging plays a critical role in the pre-operative evaluation of these patients. Familiarity with important imaging findings and potential pitfalls are invaluable for appropriate surgical planning and treatment.