E1934. Connect the Dots: Don't Forget the Skull Base Foramina in the Setting of Craniofacial Trauma
  1. Micheal Dearborn; Brooke Army Medical Center
  2. John Ritter; Brooke Army Medical Center
Whether it’s at a busy tertiary care center or a small community hospital, assessment of the skull base in the setting of trauma requires a systematic approach to ensure adequate evaluation of pertinent structures. In the setting of craniofacial trauma, evaluation of the skull base foramina is paramount as this can guide clinical management and have a direct impact on patient outcomes. This exhibit will illustrate the importance of evaluating the skull base foramina in the setting of trauma by identifying injury patterns that can compromise the structures traversing the foramina. Additionally, this exhibit will provide insight regarding surgical and medical management as it correlates with various traumatic injuries.

Educational Goals / Teaching Points
After review of this exhibit, the viewer should recognize the three major compartments of the skull base and be able to identify the major foramina. Moreover, the contents of each foramina will be identified to illustrate how involvement of specific foramina increases the severity of injury. The exhibit will also provide insight regarding what the neurosurgeon, or managing provider, might need to know to maximize patient outcomes. Lastly, data from the radiologic and neurosurgery literature will emphasize how early radiographic intervention has positively affected management.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Using cases predominantly seen at a Level 1 tertiary care center, this exhibit will demonstrate injury patterns incurred through blunt trauma, motor vehicle collisions, ballistics and blast injuries, and falls from heights. Cases will be presented via computed tomography (CT), computed tomographic angiography (CTA), 3D reconstructions and magnetic resonance imaging (MRI). In each case, dedicated discussion of the involved foramina and adjacent structures will address possible injuries and highlight findings pertinent to the radiology report.

Early recognition of injury to the skull base foramina in the setting of craniofacial trauma has direct implications on patient outcomes. By connecting the dots, radiologists can provide a more complete picture to the neurosurgeon through comprehensive reports that guide management.