Clinicoradiologic Assessment of the Cranial Nerves and Skull Base: A Primer for Neurologists in 10 Clinical Pearls

Abstract

The skull base and cranial nerves are of high neurological interest. Although the anatomy is complex, a clinicoradiologic approach using modern neuroimaging informed by history taking and physical examination can be employed to elucidate many problems in skull base neurology. This review illustrates diagnostic principles and pearls in skull base medicine with illustrative case vignettes.

Keywords

skull base - cranial nerves - neuroradiology

Publication History

Received: 02 May 2025

Accepted: 24 September 2025

Article published online:
11 November 2025

• References

• 1 Blitz AM, Choudhri AF, Chonka ZD. et al. Anatomic considerations, nomenclature, and advanced cross-sectional imaging techniques for visualization of the cranial nerve segments by MR imaging. Neuroimaging Clin N Am 2014; 24 (01) 1-15
• 2 Douglas VP, Douglas KAA, Reinshagen KL, Chwalisz BK. Case 292: Lyme neuroborreliosis. Radiology 2021; 300 (02) 484-488
• 3 Smoker WR, Reede DL. Denervation atrophy of motor cranial nerves. Neuroimaging Clin N Am 2008; 18 (02) 387-411 , xi
• 4 Ikeda R, Kobayashi T, Yoshida M. et al. Patulous Eustachian tube and otitis media with effusion as complications after trigeminal nerve injury. Otol Neurotol 2017; 38 (08) 1125-1128
• 5 Shoja MM, Oyesiku NM, Griessenauer CJ. et al. Anastomoses between lower cranial and upper cervical nerves: a comprehensive review with potential significance during skull base and neck operations, part I: trigeminal, facial, and vestibulocochlear nerves. Clin Anat 2014; 27 (01) 118-130
• 6 Shoja MM, Oyesiku NM, Shokouhi G. et al. A comprehensive review with potential significance during skull base and neck operations, Part II: glossopharyngeal, vagus, accessory, and hypoglossal nerves and cervical spinal nerves 1-4. Clin Anat 2014; 27 (01) 131-144
• 7 Ernest E. Temporal tendinitis migraine mimic. Pract Pain Manag 2006;6(4)
• 8 Douglas VP, Douglas KAA, Rizzo III JF, Chwalisz BK. Case report: orbital myositis triggering oxygen-responsive cluster headache. Cephalalgia 2020; 40 (03) 313-316
• 9 Beier D, Korsbæk JJ, Bsteh G. et al. Magnetic resonance imaging signs of idiopathic intracranial hypertension. JAMA Netw Open 2024; 7 (07) e2420138
• 10 Kimura F, Kim KS, Friedman H, Russell EJ, Breit R. MR imaging of the normal and abnormal clivus. AJR Am J Roentgenol 1990; 155 (06) 1285-1291
• 11 Anand P, Chwalisz BK. Inflammatory disorders of the skull base: a review. Curr Neurol Neurosci Rep 2019; 19 (12) 96
• 12 Saitakis G, Chwalisz BK. The neurology of IGG4-related disease. J Neurol Sci 2021; 424: 117420
• 13 Chwalisz BK, Stone JH. Neuro-ophthalmic complications of IgG4-related disease. Curr Opin Ophthalmol 2018; 29 (06) 485-494