Imaging of Central Skull Base Lesions: What the Skull Base Surgeon Needs to Know

Background: Accurate and minimally invasive diagnosis of central skull base lesions is essential as the central skull base forms the floor of the middle cranial fossa and acts as the pathway for critical neural and vascular structures. Lesions are difficult to characterize with physical examination and thus, imaging is often the primary method of preoperative assessment and characterization of lesions. The wide range of pathology, the complex anatomy of the skull base and nonspecific imaging findings can make it difficult for physicians to establish a focused differential diagnosis. Accurate characterization with imaging before intervention helps guide appropriate diagnostic interventions and management.

Purpose: The differential diagnosis of a central skull base lesion is extensive and skull base surgeons need to develop a focused differential before determining the appropriate next step for management. The goal of this pictorial essay is utilize a series of examples to provide imaging tips for that every surgeon needs to know.

Methods: A retrospective review of our radiology database, Nuance mPower, was queried for central skull base lesions from 2013 to 2018. Both CT and MRI studies were reviewed. The images from each case were reviewed by an attending neuroradiologist for quality and the presence of essential findings that define each lesion.

Results: For the pictorial essay, characteristic CT and MR images for a variety of central skull base lesions were compiled. Detailed descriptions of imaging guidelines and essential findings for each lesion were provided under imaging examples.

Conclusion: A strong understanding of the appropriate imaging modality and essential imaging findings for common central skull base lesions will help the skull base surgeon make the appropriate next steps in management.

No conflict of interest has been declared by the author(s).