Download PDF
J Neurol Surg B Skull Base 2016; 77(02): 113-123
DOI: 10.1055/s-0036-1571836
Review Article
Georg Thieme Verlag KG Stuttgart · New York

The Imaging of Large Nerve Perineural Spread

Mitesh Gandhi
1   The Department of Radiology, Princess Alexandra Hospital and Queensland Xray, Brisbane, Australia
,
Jennifer Sommerville
2   The Department of Radiology, Princess Alexandra Hospital, Brisbane, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
09 February 2016 (online)

    Permissions and Reprints

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.


 

  • References

  • 1 Australian Bureau of Statistics. National health survey: Summary of results. Health service usage and health related actions. 2012; http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/826366E0BD2E8F16CA257B39000F3011?opendocument . Accessed October 29, 2012
    PubMedGoogle Scholar
  • 2 Warner GC, Gandhi M, Panizza B. Slowly progressive cranial nerve palsies. Med J Aust 2006; 184 (12) 641-643
    CrossrefPubMedGoogle Scholar
  • 3 Carpenter EL, Bencardino JT. Focus on advanced magnetic resonance techniques in clinical practice: magnetic resonance neurography. Radiol Clin North Am 2015; 53 (3) 513-529
    CrossrefPubMedGoogle Scholar
  • 4 Gandhi MR, Panizza B, Kennedy D. Detecting and defining the anatomic extent of large nerve perineural spread of malignancy: comparing “targeted” MRI with the histologic findings following surgery. Head Neck 2011; 33 (4) 469-475
    CrossrefPubMedGoogle Scholar
  • 5 Baulch J, Gandhi M, Sommerville J, Panizza B. 3T MRI evaluation of large nerve perineural spread of head and neck cancers. J Med Imaging Radiat Oncol 2015; 59 (5) 578-585
    CrossrefPubMedGoogle Scholar
  • 6 Curtin HD. Detection of perineural spread: fat is a friend. AJNR Am J Neuroradiol 1998; 19 (8) 1385-1386
    PubMedGoogle Scholar
  • 7 Russo CP, Smoker WR, Weissman JL. MR appearance of trigeminal and hypoglossal motor denervation. AJNR Am J Neuroradiol 1997; 18 (7) 1375-1383
    PubMedGoogle Scholar
  • 8 Caldemeyer KS, Mathews VP, Righi PD, Smith RR. Imaging features and clinical significance of perineural spread or extension of head and neck tumors. Radiographics 1998; 18 (1) 97-110 , quiz 147
    CrossrefPubMedGoogle Scholar
  • 9 Maroldi R, Farina D, Borghesi A, Marconi A, Gatti E. Perineural tumor spread. Neuroimaging Clin N Am 2008; 18 (2) 413-429 , xi
    CrossrefPubMedGoogle Scholar
  • 10 Parker GD, Harnsberger HR. Clinical-radiologic issues in perineural tumor spread of malignant diseases of the extracranial head and neck. Radiographics 1991; 11 (3) 383-399
    CrossrefPubMedGoogle Scholar
  • 11 Repanos C, Mitchell D, Gandhi M, Wood M, Panizza B. Greater auricular nerve perineural spread of squamous cell carcinoma. ANZ J Surg 2012; 82 (3) 179-180
    CrossrefPubMedGoogle Scholar
  • 12 Ginsberg LE. Imaging of perineural tumor spread in head and neck cancer. Semin Ultrasound CT MR 1999; 20 (3) 175-186
    CrossrefPubMedGoogle Scholar
  • 13 Schmalfuss IM, Tart RP, Mukherji S, Mancuso AA. Perineural tumor spread along the auriculotemporal nerve. AJNR Am J Neuroradiol 2002; 23 (2) 303-311
    PubMedGoogle Scholar
  • 14 Ginsberg LE, De Monte F, Gillenwater AM. Greater superficial petrosal nerve: anatomy and MR findings in perineural tumor spread. AJNR Am J Neuroradiol 1996; 17 (2) 389-393
    PubMedGoogle Scholar
  • 15 Yang HM, Won SY, Kim HJ, Hu KS. Sihler staining study of anastomosis between the facial and trigeminal nerves in the ocular area and its clinical implications. Muscle Nerve 2013; 48 (4) 545-550
    CrossrefPubMedGoogle Scholar
  • 16 Williams LS, Mancuso AA, Mendenhall WM. Perineural spread of cutaneous squamous and basal cell carcinoma: CT and MR detection and its impact on patient management and prognosis. Int J Radiat Oncol Biol Phys 2001; 49 (4) 1061-1069
    CrossrefPubMedGoogle Scholar
  • 17 Ginsberg LE. Perineural Tumor Spread Associated with Head and Neck Malignancies. 5th ed; 2011
    CrossrefGoogle Scholar
  • 18 Paes FM, Singer AD, Checkver AN, Palmquist RA, De La Vega G, Sidani C. Perineural spread in head and neck malignancies: clinical significance and evaluation with 18F-FDG PET/CT. Radiographics 2013; 33 (6) 1717-1736
    CrossrefPubMedGoogle Scholar