Tumors of petrous bone

JL SARRAZIN, F BENOUDIBA American Hospital of Paris

Centre Hospitalo-Universitaire de Bicêtre

JFIM Barcelona nov 2014

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

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

Exploration Technique

�  CT scan �  Bone

�  Spatial Resolution

�  IRM �  Soft tissue

EXTERNAL ACOUSTIC MEAT TUMORS

Osteoma Polyp Squamous cell carcinoma Cholesteatoma

EXTERNAL ACOUSTIC MEAT TUMORS

Osteoma Cold water divers Benign

EXTERNAL ACOUSTIC MEAT TUMORS

�  Squamous cell carcinoma

�  Rhabdomyosarcoma (Children)

�  Lymphoma

� Melanoma

Staging : bone extension

Middle ear Tumors

Paraganglioma

Facial Tumor

Epidermoid Cyst

Middle ear Tumors

Paraganglioma

Paraganglioma

From glomus body

Hypervascular Tumor

- Tympanic paraganglioma

- Jugular paraganglioma

Paraganglioma

From glomus body

Hypervascular Tumor

- Tympanic paraganglioma

- Jugular paraganglioma

Tympanic paraganglioma

From glomus body near Tympanic nerve (Branch of IX)

�  sex ratio 2F/1M

�  40/50 yo

�  pulsatils tinnitus

�  Otoscopy « vascular » Tympan

�  TTT : surgery

Tympanic paraganglioma

« Vascular » Tympan �  Prominence of Jugular vein

�  Aberrant internal carotid artery

�  Persistence of stapedial artery

�  Tympanic paraganglioma

�  Jugular paraganglioma

CT scan

Middle ear Tumors Facial Tumor

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)

Schwannoma

54 yo male Facial Palsy since 6 years Deafness

39 yo male Facial Palsy since 9 months

Hemangioma

Hemangioma �  Vascular processus.

�  Along the way of facial nerve �  Geniculate ganglion

�  Internal acoustic meatus

�  Jugular foramen

Middle ear Tumors

Epidermoid Cyst

Middle ear Tumor �  CT scan and MRI

�  CT scan �  Small lesions

�  Vascular anomalie �  Bone lesion

�  MRI �  Tissular characterisation (injection, diffusion)

�  Extension

PETROUS APEX Epidermoid cyst Cartilaginous tumor Chordoma Schwannoma (V) (Cholesterol graunloma)

62 yo male Facial Palsy

Epidermoid cyst

Congenital epidermoid cyst

�  Non neo plastic timor

�  From remaining ectodermal tissue

�  Bone destruction +++

�  No history of chronic otitis

�  Normal Tympan

Chordoma

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)

Schwannoma of Trijeminal nerve

Cholesterol granuloma

PETROUS APEX

Epidermoid cyst Cartilaginous tumor Chordoma Schwannoma (V) (Cholesterol graunloma)

Inner ear Tumors

Oreille interne Schwannome (Méningiome)

AJNR septembre 2003

Jugular Foramen Paraganglioma Schwannoma Meningioma

Foramen Jugular tumors

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

Lustig LR, Am J Otol 1996;117:658–668.

Paraganglioma Schwannoma Meningioma

Bone tumors of temporal bone Chondrosarcoma Chordoma Petrous apex

Osteoma External ear

Histiocyosis Sarcoma Children

Bone dystrophy Metastasis ……

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

Sarcoma

Metastasis

Sac endolymphatic tumor

papillary epithelial neoplasm mixed type Van Hippel Lindau Disease

Where?

What?

How?

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

CONCLUSION