MR imaging of perineural tumor spread
Section snippets
Malignant disease
The most common malignancies associated with head and neck PNS are tumors of salivary, mucosal, and cutaneous origin [8], [9], [10], [11], [12], [13], [14], [15]. For salivary gland origin, typical primary sites include the parotid gland and minor salivary glands, mainly in the palate. Any histologic subtype can spread perineurally but adenoid cystic carcinoma is most notorious. Squamous cell carcinoma (SCC) of primary mucosal origin, and cutaneous SCC or desmoplastic melanoma are also commonly
Trigeminal nerve
The most commonly affected nerves in PNS are the trigeminal and facial. All three trigeminal divisions may be involved, sometimes more than one simultaneously. The maxillary (V2) and mandibular (V3) divisions are most commonly involved, but occasionally for a lesion in the appropriate location, the ophthalmic division (CN V1)may be affected [7], [19]. Fig. 5, Fig. 6, Fig. 7, Fig. 8 depict the anatomy relevant to PNS along the trigeminal nerve.
The ophthalmic division of the trigeminal nerve, V1,
Imaging of perineural tumor spread
Imaging of PNS with MR imaging is analogous to imaging with CT but is far more sensitive. Many cases of PNS are probably missed because the imaging technique is inadequate. First, the field of view must be small enough to allow visualization of the often very small structures involved: 18 cm should be the largest field of view used in imaging PNS. For pulse sequences, a minimum set of sequence would include axial T1- and T2-weighted images and axial and coronal postcontrast T1-weighted images.
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Cited by (40)
Perineural Spread of Tumor in the Skull Base and Head and Neck
2023, Oral and Maxillofacial Surgery Clinics of North AmericaPerineural Invasion and Perineural Tumor Spread in Head and Neck Cancer
2019, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :If the tumor grossly or pathologically involves the hypoglossal nerve, the authors suggest covering the hypoglossal nerve up to the hypoglossal canal. Although there is a true anatomic connection between the submandibular gland and the facial nerve via the chorda tympani, failures of VII from these tumors are rare; therefore, the facial nerve is not typically part of the elective clinical target volume.68 PNI is also notoriously associated with ACC, where tumor cells are known to infiltrate along the nerve tract beyond the main tumor mass.
The Skull Base in the Evaluation of Sinonasal Disease: Role of Computed Tomography and MR Imaging
2015, Neuroimaging Clinics of North AmericaCitation Excerpt :Tumor may also access the intracranial structures by extending through neurovascular foramina and fissures, often by PNS. Although direct extension usually involves the ASB, the focus of PNS is on the CSB.62 PNS comprises the extension of malignancy along the scaffolding of a nerve or nerve plexus63 either within the perineural space or within the nerve fascicles.
Cutaneous Malignancy of the Head and Neck
2015, Surgical Oncology Clinics of North AmericaCitation Excerpt :The clinician should have a high index of suspicion for perineural invasion in the patient with SCC, and a thorough evaluation of the sensory and motor nerves may elicit objective evidence of nerve invasion. This evidence can sometimes be obtained through preoperative imaging such as computed tomography (CT) or MRI.33,34 BCC rarely spreads to the cervical lymphatics, whereas regional spread is common in patients with SCC.
Oropharyngeal Cancer
2015, Clinical Radiation OncologyA contouring guide for head and neck cancers with perineural invasion
2014, Practical Radiation OncologyCitation Excerpt :For tumors of the parotid gland with microscopic PNI, we consider coverage to the facial nerve up to the stylomastoid foramen and the parapharyngeal space as the nerve tracks up to the skull base at the internal acoustic meatus. In those tumors that are of ACC histologic subtype, or feature gross PNI, we suggest additional coverage of the mandibular nerve from the auriculotemporal nerve up to the foramen ovale11,12 (Fig 6). The submandibular gland (SMG) is a paired structure, located in the submandibular fossa of the mandible (Fig 7A-A″).
This article was originally published in Magnetic Resonance Imaging Clinics of North America 10:3, 2002.