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Chapter 67: Neoplasms of the Temporal Bone and Skull Base

Z. Jason Qian; John S. Oghalai

INTRODUCTION

The skull base includes the frontal bone, the sphenoid bone, the temporal bone, and the occipital bone. Tumors of the temporal bone and skull base tend to arise in 1 of 3 locations: (1) the mastoid or middle ear, (2) the jugular foramen, or (3) the petroclival junction or petrous apex. Tumors of the cerebellopontine angle (CPA) and Meckel cave are not considered in this chapter (see Chapter 63, Acoustic Neuromas, and Chapter 64, Nonacoustic Lesions of the Cerebellopontine Angle). Tumors arising within the skull base are rare and usually cause few symptoms until they grow to a size in which they begin to affect cranial nerves. Table 67–1 lists the various skull base neoplasms and their imaging characteristics.

Table 67–1Radiographic appearance of skull base neoplasms.
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Table 67–1 Radiographic appearance of skull base neoplasms.
Neoplasm Most Common Site of Origin in Skull Base CT T1-Weighted MRI T2-Weighted MRI Contrast Enhancement
Paraganglioma Jugular foramen and middle ear Bone destruction Intermediate, with flow voids High, with flow voids Strong
Facial nerve schwannoma Geniculate ganglion Smooth remodeling and dilation of the surrounding bone of the facial canal Intermediate Intermediate Strong; follows the course of the facial nerve
Geniculate hemangioma Geniculate ganglion Erosion of surrounding bone with bony spicules within tumor Intermediate High Strong
Leukemia, lymphoma, and plasmacytoma Petrous apex Lytic lesion Low Intermediate Moderate
Langerhans cell histiocytosis Mastoid Irregular bone destruction; may have other skull lesions as well Intermediate High Moderate
Chondrosarcoma Petroclival junction Bone destruction, but can produce calcium matrix in 50% of tumors Intermediate High Moderate or mixed
Chordoma Clivus Bone destruction, but can have bone remnants within it Intermediate, with some areas of low signal representing mucus High Moderate or mixed
Meningioma Posterior face of temporal bone Surrounding hyperostosis and intratumoral calcification Intermediate Intermediate Strong; characteristic dural tail
Intralabyrinthine schwannoma Within the inner ear Mass within labyrinth; no bone erosion Low Intermediate Strong
Schwannoma of jugular foramen Jugular foramen and middle ear Soft-tissue mass posterior to jugular bulb; mild, smooth bone erosion Low Intermediate Strong
Rhabdomyosarcoma Anywhere, predominant tumor of children Bone destruction Intermediate High Strong
Osteosarcoma Anywhere Either lytic osteoblastic or osteolytic; may have concentric rings of calcium Intermediate High Strong
Fibrosarcoma Anywhere Bone destruction Intermediate High Strong
Adenoma Middle ear Middle ear soft-tissue mass; no bone erosion Low Intermediate Strong
Endolymphatic sac tumor Posterior face of temporal bone Bone destruction and erosion of otic capsule Mixed, due to localized areas of mucus Mixed Strong
Carcinoma Middle ear Bone destruction Intermediate Intermediate Strong
Metastatic disease Petrous apex and internal auditory canal (IAC) Lytic lesion Intermediate High Strong

The majority of skull base tumors are benign and can typically be successfully managed by an otolaryngologist specialized in neurotology and skull base surgery. Surgical approaches to these 3 areas are numerous, and the nomenclature is confusing. To remove a lesion of the middle ear ...

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