The Teaching Point

Skull base and craniocervical bone pneumatisation is a rare phenomenon, best demonstrated on CT imaging, and when identified should prompt investigation into possible causative factors, such as repetitive Valsalva's manoeuvre. The potential neurological complications, which include cranial nerve palsies, must be highlighted to the referring clinician as well as the patient so that management options and lifestyle changes can be considered.






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From the manuscript

Skull base and craniocervical bone pneumatisation: two case reports of differing presentations and a review of the literature

Free full text article: Skull base and craniocervical bone pneumatisation: two case reports of differing presentations and a review of the literature

Abstract
We report two patients with increased central skull base and craniocervical junction bone pneumatisation complicated by extra-osseous gas. One patient presented with symptoms of increasing nasal blockage and `sinus pressure` on a background of extensive nasal polyposis. He was subsequently found to have a history of repeated Valsalva`s manoeuvre, the cessation of which resulted in a rapid decrease in the amount of extra-osseous gas on imaging. The second patient presented following a minor head trauma with dysarthria from a hypoglossal nerve palsy and neck pain, with extensive intra- and extra-cranial gas including within the spinal canal (pneumorrhachis). These radiological findings have been reported previously in patients with Eustachian tube dysfunction and/or activities leading to frequently raised middle ear pressures. We review the possible aetiologies, reported risk factors, and the range of associated imaging abnormalities that may be encountered with this rare appearance.






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Keyword search:

1. skull base pneumatization

2. craniocervical pneumatization

3. hyperpneumatization

4. skull base

5. atlanto-occipital joint

6. computed tomography

7. magnetic resonance imaging

8. Valsalva`s manoeuvre

9. pneumorrhachis

10. hypoglossal nerve palsy

11. Eustachian tube dysfunction


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