By Anton Valavanis, Othmar Schubiger, Thomas P. Naidich
The cerebello-pontine perspective has consistently posed a problem to the neurosurgeon, the otoneurosurgeon, and the neuroradiologist. attitude plenty that are very small and tough to become aware of often produce signs, yet might stay silent whereas growing to be to unprecedented dimension. The neuroradiologist should have company knowl fringe of the medical manifestations of the varied perspective lesions so one can tailor his stories to the sufferers' wishes. the vast majority of perspective lesions are benign; hence winning surgical procedure has the potential of entire healing. attitude lesions ordinarily come up at the side of very important neurovascular buildings, and infrequently displace those clear of their anticipated positions. huge lesions may well attenuate the vestibulocochlear and facial nerves and skinny them over their dome. because the nerves usually stay practical, the health care provider then faces the necessity to separate the tumor from the contiguous nerve, with renovation of neurological functionality. counting on the precise place and extension of the lesion, resection may perhaps top be tried through otologic or neurosurgical techniques. The neuroradiologist needs to verify - accurately -the presence, web site, dimension, and extension( s) of the lesion and the displacement of significant neurovascular buildings as a advisor to choosing the road of surgical assault. because the arteries, veins, and nerves that traverse the attitude are effective constructions, the neuroradiologist needs to practice experiences of the very best quality to do his task effectively.
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Extra info for Clinical Imaging of the Cerebello-Pontine Angle
Ring-like enhancement in a medium-sized acoustic neurinoma. Post contrast CT. a Axial scan. The mainly hypodense acoustic neurinoma shows ring enhancement (arrows). Note the contrast layering (arrowheads), indicating the cystic nature of the tumor. b Coronal scan with the patient in supine position. Note again the contrast layering (arrowheads) 48 Acoustic Neurinoma Fig. 34. Dynamic CT in a case of a small right-sided acoustic neurinoma. The time-density curve, measured over the basilar artery (arrowheads) exhibits an initial density peak foilowed by two further small peaks (rebound-phenomenon).
Similarly, the small inferior vertical crest subdivides the inferior compartment into anterior and posterior portions. Each of these four compartments contains a specific nerve : The antero-superior compartment contains the facial nerve. The antero-inferior compartment contains the cochlear nerve. The postero-superior compartment contains the superior division of the vestibular nerve, and the postero-inferior compartment contains the inferior division of the vestibular nerve. The superior and inferior walls of the internal auditory canal are displayed most clearly in the coronal plane (Fig.
The supero-medial end of the porus merges with the posterior surface of the petrous bone. At the fundus of the canal, the falciform crest of the cribriform plate divides the canal into a smaller superior and a larger inferior compartment. A very small crest - Bill's bar - subdivides the superior compartment into anterior and posterior portions. Similarly, the small inferior vertical crest subdivides the inferior compartment into anterior and posterior portions. Each of these four compartments contains a specific nerve : The antero-superior compartment contains the facial nerve.