Skull Base Reconstruction: Demystifying Postoperative Imaging Evaluation

Abstract

Pathology affecting the skull base is challenging as a result of complex anatomy and critical neurovascular structures. A spectrum of open and endonasal endoscopic surgical approaches have evolved to maximize surgical outcomes. Postoperative CT and MR imaging can be challenging because of surgical alteration of normal anatomy, and complex reconstructions of the surgically-created defects using an arsenal of tissues and grafts. This article reviews common skull base reconstructions based on anatomic locations and surgical techniques and provides a practical approach to their postoperative imaging interpretation. Understanding the normal imaging appearance of skull base reconstruction is paramount for accurate postoperative interpretation and delineation between normal reconstructive tissue and neoplasm. The learning objectives of this paper were to understand the expected postoperative imaging appearance of the common skull base reconstructions and to distinguish between normal reconstructive tissues and neoplasm. Learning Objective: To understand the expected post-operative imaging appearance of the common skull base reconstructions and to distinguish between normal reconstructive tissues and neoplasm.