Posttreatment imaging of the skull base

The challenges of revision skull base surgery

Because the skull base is an anatomically complex structure, skull base tumors can hide easily in the crevices that interconnect the intra- and extracranial spaces and intermingle with important neurovascular structures. Often, total surgical resection of these tumors is not possible, and even with postoperative adjuvant radiotherapy, some recurrences after treatment are inevitable. Early detection of recurrent skull base tumors requires clinical vigilance and periodic imaging studies. The management of recurrent skull base tumors presents many challenges beyond those associated with primary procedures. A multidisciplinary setting that includes modern microsurgery and stereotactic radiation therapy provides patients with optimal care.

Innovations in Neuroimaging of Skull Base Pathology

Recent advances in CT and MR technology have allowed detailed imaging of the skull base with greater diagnostic accuracy. Innovations such as multidetector volumetric CT scanners with 3-D reconstructions provide soft tissue and bony detail with very high resolution for small structures such as the neural foramina. CT angiography can assess vascular structures noninvasively, and CT perfusion can help differentiate between malignant and benign tumors. MR technology has provided high-resolution, rapid volumetric sequences that are useful in skull base imaging. MR angiography and MR venography can also assess vascular structures noninvasively. PET scanning and CT/PET scanning will increasingly become a mainstay of head and neck tumor imaging for initial staging, monitoring response to therapy,and detecting recurrent disease or metastases. Many more diagnostic imaging options are available to the head and neck surgeon today than ever before.