By Anton Valavanis, Othmar Schubiger, Thomas P. Naidich
The cerebello-pontine attitude has regularly posed a problem to the neurosurgeon, the otoneurosurgeon, and the neuroradiologist. attitude lots that are very small and tough to become aware of often produce signs, yet could stay silent whereas starting to be to unprecedented measurement. The neuroradiologist should have company knowl fringe of the medical manifestations of the various attitude lesions in an effort to tailor his experiences to the sufferers' wishes. the vast majority of perspective lesions are benign; therefore winning surgical procedure has the potential of entire healing. perspective lesions often come up at the side of important neurovascular constructions, and infrequently displace those clear of their anticipated positions. huge lesions may possibly attenuate the vestibulocochlear and facial nerves and skinny them over their dome. because the nerves frequently stay practical, the doctor then faces the necessity to separate the tumor from the contiguous nerve, with protection of neurological functionality. looking on the precise position and extension of the lesion, resection might top be tried through otologic or neurosurgical techniques. The neuroradiologist needs to make certain - accurately -the presence, web site, dimension, and extension( s) of the lesion and the displacement of important neurovascular constructions as a consultant to picking the road of surgical assault. because the arteries, veins, and nerves that traverse the attitude are wonderful buildings, the neuroradiologist needs to practice reviews of the very best quality to do his activity effectively.
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Additional info for Clinical Imaging of the Cerebello-Pontine Angle
A Non contrast CT. The anterior compartment of the pontocerebellar cistern on the right side (short arrows) is dilated when compared with the normal left side (white arrowheads). The posterior compartment of the cistern is occupied by an inhomogeneous, partially hypodense mass (long arrow). Note the density difference of the contents of the two internal auditory canals (black arrowheads). b Post contrast CT. The acoustic neurinoma shows inhomogeneous enhancement (arrow). The intracanalicular tumor portion shows enhancement (open arrow), whereas the CSF-containing left internal auditory canal does not enhance (arrowhead) 42 Acoustic Neurinoma Fig.
Laterally the tentorium inserts onto the occipital and petrous bones along the courses of the transverse and superior petrosal sinuses. Anteriorly the free medial margins of the tentorium insert onto the anterior clinoid processes, while the lateral margins of the tentorium continue from the petrous pyramids to the posterior clinoid processes as the petroclinoid ligaments. In the dorsal midline, the tentorium merges with the falx, enclosing the straight sinus. The free margins of the tentorium begin at the anterior clinoid processes, pass laterally around the midbrain and end posteriorly where the vein of Galen enters the straight sinus (47,546).
A Non contrast axial CT. The right cerebellopontine angle is filled and dilated by an almost homogeneous hypodense mass (arrows) . b Post contrast CT. The hypodense tumor shows intense, but irregular enhancement The vast majority of acoustic neurinomas show substantial contrast enhancement. Enhancement is reported to occur in 90 to 100% of medium-sized and large neurinomas (159, 182, 259, 387, 427, 539, 574, 596). The enhancement is homogeneous in 74% (Fig. 30), inhomogeneous in 16% (Figs. 31 and 32) and ringlike in 10%.