RESUMO
Resumen: La anatomía de la base del cráneo es compleja. Numerosas estructuras neurovasculares vitales pasan a través de múltiples canales y agujeros ubicados en la base del cráneo. Con el avance de la tomografía computarizada (TC) y la resonancia magnética (RM), es posible la localización cada vez más precisa de lesiones y la evaluación de su relación con las estructuras neurovasculares adyacentes. El trayecto de los nervios craneales sigue un recorrido conocido y se transmiten a la cara y cuello por los forámenes de base de cráneo. La tomografía computada y la resonancia magnética son complementarias entre sí y, a menudo, se usan juntas para demostrar la extensión total de la enfermedad. La segunda parte de esta revisión se centra en el estudio radiológico de los nervios craneales.
Abstract: The skull base anatomy is complex. Many vital neurovascular structures course through the skull base canals and foramina. With the advancement of CT and MRI, the localization of lesions has become more precise as their relationship with adjacent neurovascular structures. There is a known course of the cranial nerves as well as their skull base exiting foramina to the head and neck. CT and MRI are complimentary modalities and are often used together to map the full extent of disease. The second article in this review focus on the radiologic study of the cranial nerves.
Assuntos
Humanos , Base do Crânio/inervação , Base do Crânio/diagnóstico por imagem , Nervos Cranianos/diagnóstico por imagem , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Nervos Cranianos/anatomia & histologiaRESUMO
La anatomía de la base del cráneo es compleja. Numerosas estructuras neurovasculares vitales pasan a través de múltiples canales y formámenes de la base del cráneo. Con el avance de la tomografía computarizada (TC) y la resonancia magnética (RM) es posible la localización cada vez más precisa de lesiones y la evaluación de su relación con las estructuras neurovasculares adyacentes. El trayecto de los nervios craneales sigue un recorrido conocido y se transmiten a la cara y cuello a través de los forámenes de base de cráneo. La TC y la RM son complementarias entre sí y, a menudo, se usan en conjunto para demostrar la extensión completa de la enfermedad. La primera parte de esta revisión se centra en generalidades del estudio radiológico y anatomía de base de cráneo.
The skull base anatomy is complex. Many vital neurovascular structures course through the skull base canals and foramina. With the routine use of CT and MRI, the localization of lesions has become more precise as well as their relationship with adjacent neurovascular structures. There is a known anatomical course of the cranial nerves and their skull base s they course through the foramina towards the head and neck. CT and MRI are complimentary modalities and are often used together to map the full extent of disease. The first part of this review article series focus on the radiologic approach to disease and the skull base anatomy.
Assuntos
Humanos , Base do Crânio/inervação , Base do Crânio/diagnóstico por imagem , Nervos Cranianos/anatomia & histologia , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Nervos Cranianos/diagnóstico por imagemRESUMO
INTRODUCTION: Perineural invasion is a well-recognized form of cancer dissemination. However, it has been reported only in few papers concerning cutaneous carcinomas (basal cell, BCC, and squamous cell, SCC). Moreover, the incidence is considered to be very low. Niazi and Lambert [Br J Plast Surg 1993;46:156-157] reported only 0.18% of perineural invasion among 3,355 BCCs. It is associated with high-risk subtypes, as morphea-like, as well as with an increased risk of local recurrence. No paper was found in the literature looking for perineural invasion in very aggressive skin cancers with skull base extension, with immunohistochemical analysis. METHODS: This is a retrospective review, including 35 very advanced skin carcinomas with skull base invasion (24 BCCs and 11 SCCs, operated on at a single institution from 1982 to 2000). Representative slides were immunohistochemically evaluated with antiprotein S-100, in order to enhance nerve fibers and to detect perineural invasion. The results were compared to 34 controls with tumors with a good outcome, treated in the same time frame at the same Institution. RESULTS: Twelve (50.0%) of the BCCs with skull base invasion had proven perineural invasion, as opposed to only 1 (4.6%) of the controls, and this difference was statistically significant (p < 0.001). Regarding SCCs, 7 aggressive tumors (63.6%) showed perineural invasion compared to only 1 (10.0%) of the controls, but this difference did not reach significance (p = 0.08), due to the small number of cases. CONCLUSIONS: In this series, it was demonstrated that immunohistochemically detected perineural invasion was very prevalent in advanced skin carcinomas. In addition, it was statistically associated with extremely aggressive BCCs with skull base invasion.