jl sarrazin f benoudiba tumors of petrous bone jfim 2014
TRANSCRIPT
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Tumors of petrous bone
JL SARRAZIN, F BENOUDIBA American Hospital of Paris
Centre Hospitalo-Universitaire de Bicêtre
JFIM Barcelona nov 2014
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Bone Tumors - Osteoma - Chordoma - Cartilaginous tumors - Sarcomas - Metastasis - Histiocytosis
Nervous Tumors Schwannomas
Vascular Tumors
Paragangliomas Hemangiomas Tumors of sac endolymphatic Epidermoid Tumors
Meningeal Tumors Meningiomas
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Petrous apex Cartilaginous tumors Epidermoid cyst (Chloesterol granuloma)
Middle ear Paragangliomas Epidermoid cyst (Facial) Schwannoma
Inner ear Schwannoma Meningioma
Jugular Foramen Paraganglioma Schwannoma Meningioma
External ear Osteoma Polyp Squamous cell carcinoma
Ubiquitous Bone tumors
Posterior petrous bone Endolymphatic sac tumor
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Exploration Technique
� CT scan � Bone
� Spatial Resolution
� IRM � Soft tissue
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EXTERNAL ACOUSTIC MEAT TUMORS
Osteoma Polyp Squamous cell carcinoma Cholesteatoma
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EXTERNAL ACOUSTIC MEAT TUMORS
Osteoma Cold water divers Benign
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EXTERNAL ACOUSTIC MEAT TUMORS
� Squamous cell carcinoma
� Rhabdomyosarcoma (Children)
� Lymphoma
� Melanoma
Staging : bone extension
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Middle ear Tumors
Paraganglioma
Facial Tumor
Epidermoid Cyst
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Middle ear Tumors
Paraganglioma
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Paraganglioma
From glomus body
Hypervascular Tumor
- Tympanic paraganglioma
- Jugular paraganglioma
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Paraganglioma
From glomus body
Hypervascular Tumor
- Tympanic paraganglioma
- Jugular paraganglioma
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Tympanic paraganglioma
From glomus body near Tympanic nerve (Branch of IX)
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� sex ratio 2F/1M
� 40/50 yo
� pulsatils tinnitus
� Otoscopy « vascular » Tympan
� TTT : surgery
Tympanic paraganglioma
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« Vascular » Tympan � Prominence of Jugular vein
� Aberrant internal carotid artery
� Persistence of stapedial artery
� Tympanic paraganglioma
� Jugular paraganglioma
CT scan
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Middle ear Tumors Facial Tumor
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Tumor of Facial Nerve � Origin
Geniculate ganglion +++ Labyrinthine segment (VII1) Tympanic segment (VII2) Mastoid segment (VII3)
� Symptoms : sometimes modest
� Imaging CT Scan : Bone destruction, diagnosis MRI : Tumor, extension
Schwannoma, (Hemangioma)
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Schwannoma
54 yo male Facial Palsy since 6 years Deafness
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39 yo male Facial Palsy since 9 months
Hemangioma
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Hemangioma � Vascular processus.
� Along the way of facial nerve � Geniculate ganglion
� Internal acoustic meatus
� Jugular foramen
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Middle ear Tumors
Epidermoid Cyst
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Middle ear Tumor � CT scan and MRI
� CT scan � Small lesions
� Vascular anomalie � Bone lesion
� MRI � Tissular characterisation (injection, diffusion)
� Extension
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PETROUS APEX Epidermoid cyst Cartilaginous tumor Chordoma Schwannoma (V) (Cholesterol graunloma)
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62 yo male Facial Palsy
Epidermoid cyst
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Congenital epidermoid cyst
� Non neo plastic timor
� From remaining ectodermal tissue
� Bone destruction +++
� No history of chronic otitis
� Normal Tympan
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Chordoma
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PETROUS APEX : BONE TUMORS
� Chordoma � arise from cellular remnants of the notochord. � Location : clivus � Slow-growing neoplasm with local agressiviness.
� Chondrosarcoma � Most common of skull base lesion
� Chondrome ou chondrosarcome
T1 w : Hypo intense en T1
T2w : Hyper intense en T2
T1W + Gd : heterogeneous enhancement
Calcifications (CT scan)
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Schwannoma of Trijeminal nerve
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Cholesterol granuloma
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PETROUS APEX
Epidermoid cyst Cartilaginous tumor Chordoma Schwannoma (V) (Cholesterol graunloma)
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Inner ear Tumors
Oreille interne Schwannome (Méningiome)
AJNR septembre 2003
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Jugular Foramen Paraganglioma Schwannoma Meningioma
Foramen Jugular tumors
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Veine Jugulaire interne
Os temporal
Os occipital
Ligament pétro occipital
IX
X A méningée post
XI
D’après Kamina
Chandranath Sen, Neurosurgery, Vol. 48, No. 4, April 2001
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Lustig LR, Am J Otol 1996;117:658–668.
Paraganglioma Schwannoma Meningioma
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Bone tumors of temporal bone Chondrosarcoma Chordoma Petrous apex
Osteoma External ear
Histiocyosis Sarcoma Children
Bone dystrophy Metastasis ……
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Histiocytosis Histiocytic proliferation with bone destruction
Children : 95%
Symptoms Facial palsy Atypic osteitis
CT : Bone lysis execpt ossicles
MR :
T2W : Hyper intense
T1W gd : enhancement
Diffusion : normal
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Sarcoma
Metastasis
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Sac endolymphatic tumor
papillary epithelial neoplasm mixed type Van Hippel Lindau Disease
Where?
What?
How?
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Petrous apex Cartilaginous tumors Epidermoid cyst (Chloesterol granuloma)
Middle ear Paragangliomas Epidermoid cyst (Facial) Schwannoma
Inner ear Schwannoma Meningioma
Jugular Foramen Paraganglioma Schwannoma Meningioma
External ear Osteoma Polyp Squamous cell carcinoma
Ubiquitous Bone tumors
Posterior petrous bone Endolymphatic sac tumor
CT scan +
MRI
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CONCLUSION