By: Nour-Eldin A Mohammed

Referrence:Stephan Chapman 2003

Extra-axial area lateral to the prepontine cistern containing CSF, arachnoid tissue, cranial nerves and their associated vessels. Borders

Medial: lateral surface of the brainstem Lateral : petrous bone Superior : middle cerebellar peduncle & cerebellum Inferior : arachnoid tissue of lower cranial nerves Posterior : cerbellar peduncle

1. 2. 3. 4. 5. 6. 7.

Vestibular Schwannoma (acoustic neuroma). Most Common Cause Meningioma Epidermoid cyst Trigeminal neuroma Vertebrobasilar system aneurysm Metastases Skull base/temporal bone tumours:eg, glomus tumors,metastases,cholesterol granuloma

8.

Skull base infection:osteomyelitis of the petrous apex (Gradengos

syndrome) , Malignant otitis externa

Comprises 60-92% of CPA lesions

Involve the vestibular division of the 8th cranial nerve

Features of Acoustic Neuroma:

1. Centered over the petrous bone 2. Acute angle with the petrous bone 3. Extension into the internal auditory canal 4. Homogenous enhacement 5. No dural tail 6. No calcifications

Second most common CPA lesion 3-7 %

Arise from cap cells near arachnoid villi which

are more prominent near cranial nerve

foramina and venous sinuses.

Usually arise from posterior surface of the petrous bone and usually do not extend into IAC

Features of Meningioma: 1. Broad base over the petrous bone 2. Homogenous signal 3. A small toungue extension into the internal auditory canal without widening it 4. Homogenous enhacement 5. dural tail 6. Calcifications , psammoma bodies 7. Hyperostosis

Accounts for 2-6 % of CPA masses

Congenital lesions that present in adulthood Rests of ectodermal tissue containing stratified squamous

lining and keratin

May arise within the temporal bone or in the CPA

Features of Epidermoid: 1. Low density Cyst with lobulated margin 2. CSF like signal (with high signal in diffusion,flair and proton seq 3. May exert extensive mass effect 4. Also occur parasellar and rarely itra diploic

TI WI

T2 WI

Proton WI

Similar to vestibular neuoma but arises from the trigeminal nerve

1. Vertebrobasilar dolichoectasia: Enlongation and dilitation of the vertebrobasilar artery. Symptomas : Facial spasm, trigeminal neuralgia 2. AICA loop May loop over, under, or between CN VII & CN VIII. Symptoms - vertigo 3. Giant Aneurysms 4. Hemangioma 5. Paragangliomas (may extend to CPA) Glomus Jugulare Glomus Tympanicum

Anterior inferior cerebellar artery Giant aneurysm