PURPOSE: Auditory nerve injury is one of the most common nerve injury complications of skull base fractures. However, there is currently a lack of auxiliary examination methods for its direct diagnosis. The purpose of this study was to find a more efficient and accurate means of diagnosis for auditory nerve injury. METHODS: Through retrospectively analyzing the results of brainstem auditory evoked potential (BAEP) and high-resolution CT (HRCT) in 37 patients with hearing impairment following trauma from January 1, 2018 to July 31, 2020, the role of the two inspection methods in the diagnosis of auditory nerve injury was studied. Inclusion criteria were patient had a clear history of trauma and unilateral hearing impairment after trauma; while exclusion criteria were: (1) severe patient with a Glasgow coma scale score ≤5 because these patients were classified as severe head injury and admitted to the intensive care unit, (2) patient in the subacute stage admitted 72 h after trauma, and (3) patient with prior hearing impairment before trauma. According to Goodman's classification of hearing impairment, the patients were divided into low/medium/severe injury groups. In addition, patients were divided into HRCT-positive and negative groups for further investigation with their BAEP results. The positive rates of BEAP for each group were observed, and the results were analyzed by Chi-square test (p < 0.05, regarded as statistical difference). RESULTS: A total of 37 patients were included, including 21 males and 16 females. All of them were hospitalized patients with GCS score of 6-15 at the time of admission. The BAEP positive rate in the medium and severe injury group was 100%, which was significantly higher than that in the low injury group (27.27%) (p < 0.01). The rate of BEAP positivity was significantly higher in the HRCT-positive group (20/30, 66.7%) than in the HRCT-negative group (1/7, 14.3%) (p < 0.05). Twenty patients (54.05%) were both positive for BEAP and HRCT test, and considered to have auditory nerve damage. Six patients (16.22%) were both negative for BEAP and HRCT test, and 10 patients (27.03%) were BAEP-negative but HRCT-positive: all the 16 patients were considered as non-neurological injury. The rest 1 case (2.70%) was BAEP-positive but HRCT-negative, which we speculate may have auditory nerve concussion. CONCLUSION By way of BAEP combining with skull base HRCT, we may improve the accuracy of the diagnosis of auditory nerve injury. Such a diagnostic strategy may be beneficial to guiding treatment plans and evaluating prognosis.
Cochlear Nerve ; Evoked Potentials, Auditory, Brain Stem/physiology* ; Female ; Hearing Loss ; Humans ; Male ; Retrospective Studies ; Skull Base/diagnostic imaging* ; Tomography, X-Ray Computed

OBJECTIVE: To establish an animal model with malignant tumor in the skull base-infratemporal region, and to explore the role of iodine staining technique in identifying tumor tissues with Micro-CT data. METHODS: Sedation anesthesia was carried out on 12 BABL/c nude mice using inhaled isoflurane, and then WSU-HN6 cells that cultured and immortalized from human tongue squamous cell carcinoma were injected into the right infratemporal fossa via the submandibular area. The procedure was carried out under ultrasonographic guidance. The nude mice were sacrificed after 3 weeks observation. The head specimens were fixed and scanned by Micro-CT, and repeated scans were performed after staining with 3.75% compound iodine solution. Following decalcification in 20% EDTA for 2-4 weeks, the head specimens were embedded and sectioned. Hematoxylin and eosin staining and Pan-Keratin immunohistochemical staining were carried out. Bright-field microscopy and stereomicroscopy were used to visualize. The Micro-CT data were analyzed using iPlan software (Brainlab). RESULTS: Non-traumatic ultrasonography was used to guide HN-6 cells injection and confirm skull-base tumor formation in all the animals. Ultrasonographic guidance reduced the risk of cervical vessel injury when transferring tumor cells into the skull base space. An obvious asymmetrical appearance was detected via ultrasonography 3 weeks after tumor cell injection. The Micro-CT analysis showed that the bone was obviously damaged on the right side of the skull base, but the soft tissue image was unrecognizable. After four days staining with compound iodine solution, the morphology of the tumor and surrounding soft tissue could be clearly identified. Hematoxylin and eosin staining showed the tumor formation of the right infratemporal fossa region accompanied by bone destruction. Human keratin immunohistochemical staining showed that the tumor tissue originated from human squamous cell carcinoma, and the polynuclear osteoclasts could be seen at the margin of the skull base bone resorption. CONCLUSION The animal model with malignant tumor in the skull base-infratemporal region could be successfully established via submandibular injection under ultrasound-guidance. Bone changes of the skull were easily observed on Micro-CT, but the tumor counter was not able to be distinguished from surrounding soft tissue. The 3.75% compound iodine staining of the head specimen could help discern the tumor and surrounding soft tissue in more details.
Animals ; Carcinoma, Squamous Cell/diagnostic imaging* ; Infratemporal Fossa ; Iodine ; Mice ; Mice, Nude ; Skull Base ; Staining and Labeling ; Tongue Neoplasms ; X-Ray Microtomography

Objective: To explore the diagnosis and clinical features of internal carotid artery aneurysm in the skull base. Methods: The data of 15 patients with internal carotid aneurysms in the skull base diagnosed and treated by digital subtraction angiography (DSA) or CT angiography (CTA) in the Provincial Hospital Affiliated to Shandong First Medical University from 1995 to 2017 were collected and analyzed. Among the 15 patients, 12 were males, and 3 were females, aging from 17 to 67 years old, with a median age of 44 years. Thirteen patients were diagnosed by DSA; the other two patients were diagnosed by CTA. Thirteen patients were diagnosed with pseudoaneurysm with the first symptom of epistaxis, in which eight patients underwent head trauma and 5 underwent radiotherapy of skull base tumor. The other two patients were diagnosed with true aneurysm presented headache and cranial nerve disorder. All patients were followed up for 2 to 12 years after treatment to see whether they were cured and survived. Results: Among the eight patients with a history of trauma, five patients were cured by embolization, two patients without embolization died of massive epistaxis, one patient died of progressive cerebral infarction after embolization. Among the five patients with radiotherapy of skull base tumor, one patient died of cerebral infarction after embolization, two patients died out of the hospital due to the recurrence of the primary tumor and intracranial invasion, one patient recovered well after embolization and surgical operation, one patient gave up treatment and died of massive hemorrhage out of hospital. In the other two patients with symptom of headache, one received embolization treatment outside the hospital after receiving mistake operation, and another one gave up treatment and died due to personal reasons. In total, four patients died in hospital, four died out of the hospital, and seven patients survived. Conclusions: Internal carotid artery aneurysm is a high-risk disease of anterior and middle skull base. For patients with epistaxis with a history of trauma and radiotherapy or patients with headaches and cranial nerve disorders, the possibility of the internal carotid artery aneurysm should be considered, in which DSA or CTA examination is essentially required for ensured diagnosis and disease evaluation.. The correct diagnosis and treatment by the otolaryngologist are crucial to the prognosis of the patient.
Adolescent ; Adult ; Aged ; Carotid Artery, Internal/diagnostic imaging* ; Female ; Humans ; Intracranial Aneurysm/therapy* ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Retrospective Studies ; Skull Base/diagnostic imaging* ; Young Adult

Carotid Artery Injuries/etiology* ; Carotid Artery, Internal/diagnostic imaging* ; Foreign Bodies/complications* ; Humans ; Skull ; Skull Base/diagnostic imaging*

Cranial Fossa, Anterior ; Humans ; Liposarcoma, Myxoid ; diagnostic imaging ; metabolism ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; S100 Proteins ; metabolism ; Skull Base Neoplasms ; diagnostic imaging ; metabolism ; pathology ; Tomography, X-Ray Computed

OBJECTIVE: The harvesting procedures on cadaver heads and a radioanatomic study of measuring dimensions of skull base by endoscopic endonasal approach were performed. The measurements could do help to design the nasoseptal mucoperiosteum and improve the rate of repair success. METHOD: The surgical procedures were demonstrated on cadaver heads specimens. Then 20 adult CT scans of sinus and skull base were calculated by workstations. The dimensions of three different skull base (the defect of anterior skull base/cribriform plate approach, sellar region/planum sphenoidale region and clivus region) of maximum areas, length and width, were measured. And with these data the nasoseptal flap were designed for providing enough area to cover the defect. The distance from the projection of sphenopalatine foramen to related area of skull base were plused for obtaining desired the length of nasoseptal flap. RESULT: The mean length from the projection of sphenopalatine to the anterior skull base, planum/sella area and clivus were 49.56 mm, 57.47 and 67.19 mm, respectively. The means of areas of anterior dural defect, transsellar defect and panclivectomy were 16.13 cm2, 14.03 cm2 and 13.12 cm2, respectively. The average length of the nasoseptal flap ranged between 64.71-65.93 mm, the width ranged between 28.57-30.95 mm with an average area of 22.95 cm2. CONCLUSION One side of nasal septal flap can provide enough area to reconstruct the anterior skull base and planum/sella area. In some cases, the flap can not completely cover the area of clivus region because of the limitation of its length.
Adult ; Endoscopy ; methods ; Humans ; Nasal Septum ; anatomy & histology ; diagnostic imaging ; transplantation ; Skull Base ; diagnostic imaging ; surgery ; Surgical Flaps ; Tomography, X-Ray Computed

OBJECTIVE: To discuss imaging characteristics of CT, MRI of tumors involving skull base in the parapharyngeal space,maximatily limit and improve the diagnosis rate of tumors involving skull base in the parapharyngeal space. METHOD: Thirty-one patients with tumors involving skull base in the parapharyngeal space treated in our department were collected and reviewed. All the patients have pathological diagnosis and were examined by CT and/or MRI. To explore shape of tumor, its relation with surrounding structures, CT shows density size and the MRI signal directly through retrospective analysis of imaging characteristics of CT, MRI. RESULT: In all the 31 cases, 19 tumors were schwannoma, 8 tumors were mixed tumor of salivary gland, 2 tumors were carotid body tumor. 2 tumors were nasopharyngeal carcinoma involving skull base. Schwannomas and salivary gland mixed tumor can be expressed as round or oval with periphery smooth, and had intact capsule. The tumors had necrosis, sac variable area. Pleomorphic adenoma are all derived from deep parotid. Schwannoma had clear boundary with deep parotid. The effect of cavum nasopharyngeal and cavum oropharyngeal is relevant to tumor sizes and locations. Imaging characteristics of CT, MRI for carotid body tumor show soft tissue mass with attenuation similar to that of muscle. CT enhancement scan show intense enhancement. MRI show imaging of flowing empty vein. Imaging characteristics of MRI for nasopharyngeal carcinoma involving skull base in the parapharyngeal space show oval mass with low density signal, T1WI enhancement scan show necrosis, sac variable area. CONCLUSION CT and MRI could provide the position, size, boundary of the tumor and its relationship with cervical blood vessels well, which were important to operation schemes. CT and MRI before operation are valuable to the treatment of PPS tumors.
Adult ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pharyngeal Neoplasms ; diagnostic imaging ; pathology ; Retrospective Studies ; Skull Base Neoplasms ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVETraditional Chinese medicine (TCM) is a well established and time-honored practice in China, employing syndrome differentiation as a basis for the treatment of disease. According to different TCM syndrome typing findings, combining modern medical methods with TCM approaches can improve the quality of life and comprehensive effect on patients with nasopharyngeal carcinoma (NPC). This study investigated the relationship between TCM syndrome typing and imaging characterization to radiosensitivity as to provide objective evidence for the integration of Chinese and modern medical approaches in the treatment of NPC.

METHODSPrior to treatment, TCM syndrome typing, computed tomography (CT) and magnetic resonance imaging (MRI) were performed on 147 patients pathologically classified with NPC. The status of tumor remission was radiologically evaluated at accumulated doses of 20 Gy, 40 Gy and 60 Gy, and at 3 months after completion of radiotherapy. Statistical results were analyzed by the Friedman and K-W test procedures.

RESULTSPrior to treatment, TCM syndrome typing of NPC included Lung Heat, Blood Stasis, Phlegm Congealment and Blood Stasis-Phlegm Congealment. Lung Heat typing accounted for the highest proportion at 34.7% (51/147), followed by Phlegm Congealment at 32.7% (48/147), Blood Stasis at 17.0% (25/147) and Blood Stasis-Phlegm Congealment at 15.7% (23/147). Radiological imaging demonstrated a higher incidence of cervical lymph node metastases in Phlegm Congealment and Blood Stasis-Phlegm Congealment types (P<0.05), while Blood Stasis and Blood Stasis-Phlegm Congealment types were more prone to skull base invasion (P<0.05). Residual tumor size was larger in Blood Stasis and Blood Stasis-Phlegm Congealment types than in Lung Heat and Phlegm Congealment types after 3 months of treatment (P<0.05).

CONCLUSIONSDifferent radiological manifestations were observed in TCM syndrome typed NPC patients, with lesser radiosensitivity demonstrated in the Blood Stasis and the Blood Stasis-Phlegm Congealment types relative to the Lung Heat and Phlegm Congealment types.

Adolescent ; Adult ; Aged ; Child ; Diagnosis, Differential ; Female ; Humans ; Lymphatic Metastasis ; Magnetic Resonance Imaging ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Nasopharyngeal Neoplasms ; classification ; diagnosis ; diagnostic imaging ; radiotherapy ; Neoplasm Invasiveness ; Neoplasm, Residual ; pathology ; Radiation Tolerance ; Skull Base ; pathology ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVE: To investigate the causes of misdiagnosis for skull base lesions by PET-CT, and to recognize the working principal and the false-positive results of PET-CT for reducing the misdiagnosis rate. METHOD: The lesions of case 1 involved the pharynx nasalis, pterygopalatine fossa, and orbital apex base of skull, and the lesions of case 2 involved the base of sella were performed with CT, MRI and PET-CT examination. Both of the cases were treated with surgery and histopathologic examination. RESULT: Two cases were diagnosed as nasopharyngeal carcinoma and carcinoma of base of sella by PET-CT, respectively. However, they were finally diagnosed mycosis and pituitary tumor by histopathologic examination after operation. CONCLUSION PET-CT examination in the skull base lesions may give false-positive result. Both clinical information and other imaging examinations should be considered to reduce the misdiagnosis skull base lesions only by PET-CT.
Diagnostic Errors ; Female ; Humans ; Middle Aged ; Positron-Emission Tomography ; Skull Base ; diagnostic imaging ; Skull Base Neoplasms ; diagnostic imaging

OBJECTIVE: To evaluate the imaging characteristics of B-cell non-Hodgkin lymphoma of skull base. METHOD: Two patients with B-cell non-Hodgkin lymphoma of skull base in our hospital were reported, meanwhile the imaging characteristics were summarized and analyzed with the related literature. RESULT: The imaging feature of B-cell non-Hodgkin lymphoma of skull base was equal or low signal on MR T2-weighted and not obviously enhanced. The width of the soft tissue invaded in intracalvarium appeared much bigger than the width of bone destruction, and the lesion infiltrated along the dural surface. CONCLUSION Characteristic imaging appearance of B-cell non-Hodgkin lymphoma of skull base have the significance in diagnosis and differential diagnosis.
Adult ; Child, Preschool ; Humans ; Lymphoma, B-Cell ; diagnostic imaging ; pathology ; Lymphoma, Non-Hodgkin ; diagnostic imaging ; pathology ; Magnetic Resonance Imaging ; Male ; Skull Base Neoplasms ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed