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Masticator Space CNV3 Perineural Tumor
Bronwyn E. Hamilton, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Perineural tumor (PNT) of masticator space (MS) is malignant spread along CNV3 (mandibular branch of trigeminal nerve)
            • Synonyms

              • PNT spread, PNT invasion
              • Trigeminal ganglion = gasserian ganglion, semilunar ganglion
            • Definitions

              • CNV3: 3rd division of trigeminal nerve (CNV)
              • CNV3 PNT: Extension of malignancy along CNV3 allowing spread from MS though foramen ovale into Meckel cave (MC)
              • MC: Small cistern for CNV
                • Contains trigeminal ganglion in anterior aspect of MC

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Tsutsumi S et al: The emissary veins of the foramen ovale: an anatomical study using magnetic resonance imaging. Surg Radiol Anat. 42(7):771-7, 2020
                                          2. Agarwal M et al: Perineural tumor spread in head and neck malignancies. Semin Roentgenol. 54(3):258-75, 2019
                                          3. Bakst RL et al: Perineural invasion and perineural tumor spread in head and neck cancer. Int J Radiat Oncol Biol Phys. 103(5):1109-24, 2019
                                          4. Sipprell WH 3rd et al: Cranial neuropathies as the presenting symptom of cutaneous squamous cell carcinoma. JAAD Case Rep. 5(12):1037-40, 2019
                                          5. Dankbaar JW et al: Easily detected signs of perineural tumour spread in head and neck cancer. Insights Imaging. 9(6):1089-95, 2018
                                          6. Kirsch CFE et al: Practical tips for MR imaging of perineural tumor spread. Magn Reson Imaging Clin N Am. 26(1):85-100, 2018
                                          7. Malhotra A et al: Neuroimaging of Meckel's cave in normal and disease conditions. Insights Imaging. 9(4):499-510, 2018
                                          8. Badger D et al: Imaging of perineural spread in head and neck cancer. Radiol Clin North Am. 55(1):139-49, 2017
                                          9. Warren TA et al: The natural history and treatment outcomes of perineural spread of malignancy within the head and neck. J Neurol Surg B Skull Base. 77(2):107-12, 2016
                                          10. Singh FM et al: Patterns of spread of head and neck adenoid cystic carcinoma. Clin Radiol. 70(6):644-53, 2015
                                          11. Paes FM et al: Perineural spread in head and neck malignancies: clinical significance and evaluation with 18F-FDG PET/CT. Radiographics. 33(6):1717-36, 2013
                                          12. Lee TJ et al: Perineural spread of melanoma demonstrated by F-18 FDG PET with MRI and pathologic correlation. Clin Nucl Med. 33(2):106-8, 2008
                                          13. DeMonte F et al: Transmaxillary exploration of the intracranial portion of the maxillary nerve in malignant perineural disease. Technical note. J Neurosurg. 107(3):672-7, 2007
                                          14. Hanna E et al: The sensitivity and specificity of high-resolution imaging in evaluating perineural spread of adenoid cystic carcinoma to the skull base. Arch Otolaryngol Head Neck Surg. 133(6):541-5, 2007
                                          15. Nemec SF et al: Perineural tumor spread in malignant head and neck tumors. Top Magn Reson Imaging. 18(6):467-71, 2007
                                          16. Padhya TA et al: Perineural extension to the skull base from early cutaneous malignancies of the midface. Otolaryngol Head Neck Surg. 137(5):742-6, 2007
                                          17. Ojiri H: Perineural spread in head and neck malignancies. Radiat Med. 24(1):1-8, 2006
                                          18. Rumboldt Z et al: Imaging in head and neck cancer. Curr Treat Options Oncol. 7(1):23-34, 2006
                                          19. Kalina P et al: Perineural extension of facial melanoma. Neuroradiology. 47(5):372-4, 2005
                                          20. Chang PC et al: Perineural spread of malignant melanoma of the head and neck: clinical and imaging features. AJNR Am J Neuroradiol. 25(1):5-11, 2004
                                          21. Curtin HD: Detection of perineural spread: fat suppression versus no fat suppression. AJNR Am J Neuroradiol. 25(1):1-3, 2004
                                          22. Chong V: The skull base in oncologic imaging. Cancer Imaging. 4(1):5-6, 2003
                                          23. Williams LS et al: MR imaging of the trigeminal ganglion, nerve, and the perineural vascular plexus: normal appearance and variants with correlation to cadaver specimens. AJNR Am J Neuroradiol. 24(7):1317-23, 2003
                                          24. Ginsberg LE: MR imaging of perineural tumor spread. Magn Reson Imaging Clin N Am. 10(3):511-25, vi, 2002
                                          25. Schmalfuss IM et al: Perineural tumor spread along the auriculotemporal nerve. AJNR Am J Neuroradiol. 23(2):303-11, 2002
                                          26. Boerman RH et al: Trigeminal neuropathy secondary to perineural invasion of head and neck carcinomas. Neurology. 53(1):213-6, 1999
                                          27. Curtin HD: Detection of perineural spread: fat is a friend. AJNR Am J Neuroradiol. 19(8):1385-6, 1998
                                          28. Majoie CB et al: Perineural tumor extension along the trigeminal nerve: magnetic resonance imaging findings. Eur J Radiol. 24(3):191-205, 1997
                                          29. Eisen MD et al: Use of preoperative MR to predict dural, perineural, and venous sinus invasion of skull base tumors. AJNR Am J Neuroradiol. 17(10):1937-45, 1996
                                          30. Su CY et al: Perineural invasion of the trigeminal nerve in patients with nasopharyngeal carcinoma. Imaging and clinical correlations. Cancer. 78(10):2063-9, 1996
                                          31. Schifter M et al: Perineural spread of squamous cell carcinoma involving trigeminal and facial nerves. Oral Surg Oral Med Oral Pathol. 75(5):587-90, 1993
                                          32. Parker GD et al: Clinical-radiologic issues in perineural tumor spread of malignant diseases of the extracranial head and neck. Radiographics. 11(3):383-99, 1991
                                          33. Laine FJ et al: Perineural tumor extension through the foramen ovale: evaluation with MR imaging. Radiology. 174(1):65-71, 1990
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Perineural tumor (PNT) of masticator space (MS) is malignant spread along CNV3 (mandibular branch of trigeminal nerve)
                                                    • Synonyms

                                                      • PNT spread, PNT invasion
                                                      • Trigeminal ganglion = gasserian ganglion, semilunar ganglion
                                                    • Definitions

                                                      • CNV3: 3rd division of trigeminal nerve (CNV)
                                                      • CNV3 PNT: Extension of malignancy along CNV3 allowing spread from MS though foramen ovale into Meckel cave (MC)
                                                      • MC: Small cistern for CNV
                                                        • Contains trigeminal ganglion in anterior aspect of MC

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Nuclear Medicine Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Tsutsumi S et al: The emissary veins of the foramen ovale: an anatomical study using magnetic resonance imaging. Surg Radiol Anat. 42(7):771-7, 2020
                                                                                  2. Agarwal M et al: Perineural tumor spread in head and neck malignancies. Semin Roentgenol. 54(3):258-75, 2019
                                                                                  3. Bakst RL et al: Perineural invasion and perineural tumor spread in head and neck cancer. Int J Radiat Oncol Biol Phys. 103(5):1109-24, 2019
                                                                                  4. Sipprell WH 3rd et al: Cranial neuropathies as the presenting symptom of cutaneous squamous cell carcinoma. JAAD Case Rep. 5(12):1037-40, 2019
                                                                                  5. Dankbaar JW et al: Easily detected signs of perineural tumour spread in head and neck cancer. Insights Imaging. 9(6):1089-95, 2018
                                                                                  6. Kirsch CFE et al: Practical tips for MR imaging of perineural tumor spread. Magn Reson Imaging Clin N Am. 26(1):85-100, 2018
                                                                                  7. Malhotra A et al: Neuroimaging of Meckel's cave in normal and disease conditions. Insights Imaging. 9(4):499-510, 2018
                                                                                  8. Badger D et al: Imaging of perineural spread in head and neck cancer. Radiol Clin North Am. 55(1):139-49, 2017
                                                                                  9. Warren TA et al: The natural history and treatment outcomes of perineural spread of malignancy within the head and neck. J Neurol Surg B Skull Base. 77(2):107-12, 2016
                                                                                  10. Singh FM et al: Patterns of spread of head and neck adenoid cystic carcinoma. Clin Radiol. 70(6):644-53, 2015
                                                                                  11. Paes FM et al: Perineural spread in head and neck malignancies: clinical significance and evaluation with 18F-FDG PET/CT. Radiographics. 33(6):1717-36, 2013
                                                                                  12. Lee TJ et al: Perineural spread of melanoma demonstrated by F-18 FDG PET with MRI and pathologic correlation. Clin Nucl Med. 33(2):106-8, 2008
                                                                                  13. DeMonte F et al: Transmaxillary exploration of the intracranial portion of the maxillary nerve in malignant perineural disease. Technical note. J Neurosurg. 107(3):672-7, 2007
                                                                                  14. Hanna E et al: The sensitivity and specificity of high-resolution imaging in evaluating perineural spread of adenoid cystic carcinoma to the skull base. Arch Otolaryngol Head Neck Surg. 133(6):541-5, 2007
                                                                                  15. Nemec SF et al: Perineural tumor spread in malignant head and neck tumors. Top Magn Reson Imaging. 18(6):467-71, 2007
                                                                                  16. Padhya TA et al: Perineural extension to the skull base from early cutaneous malignancies of the midface. Otolaryngol Head Neck Surg. 137(5):742-6, 2007
                                                                                  17. Ojiri H: Perineural spread in head and neck malignancies. Radiat Med. 24(1):1-8, 2006
                                                                                  18. Rumboldt Z et al: Imaging in head and neck cancer. Curr Treat Options Oncol. 7(1):23-34, 2006
                                                                                  19. Kalina P et al: Perineural extension of facial melanoma. Neuroradiology. 47(5):372-4, 2005
                                                                                  20. Chang PC et al: Perineural spread of malignant melanoma of the head and neck: clinical and imaging features. AJNR Am J Neuroradiol. 25(1):5-11, 2004
                                                                                  21. Curtin HD: Detection of perineural spread: fat suppression versus no fat suppression. AJNR Am J Neuroradiol. 25(1):1-3, 2004
                                                                                  22. Chong V: The skull base in oncologic imaging. Cancer Imaging. 4(1):5-6, 2003
                                                                                  23. Williams LS et al: MR imaging of the trigeminal ganglion, nerve, and the perineural vascular plexus: normal appearance and variants with correlation to cadaver specimens. AJNR Am J Neuroradiol. 24(7):1317-23, 2003
                                                                                  24. Ginsberg LE: MR imaging of perineural tumor spread. Magn Reson Imaging Clin N Am. 10(3):511-25, vi, 2002
                                                                                  25. Schmalfuss IM et al: Perineural tumor spread along the auriculotemporal nerve. AJNR Am J Neuroradiol. 23(2):303-11, 2002
                                                                                  26. Boerman RH et al: Trigeminal neuropathy secondary to perineural invasion of head and neck carcinomas. Neurology. 53(1):213-6, 1999
                                                                                  27. Curtin HD: Detection of perineural spread: fat is a friend. AJNR Am J Neuroradiol. 19(8):1385-6, 1998
                                                                                  28. Majoie CB et al: Perineural tumor extension along the trigeminal nerve: magnetic resonance imaging findings. Eur J Radiol. 24(3):191-205, 1997
                                                                                  29. Eisen MD et al: Use of preoperative MR to predict dural, perineural, and venous sinus invasion of skull base tumors. AJNR Am J Neuroradiol. 17(10):1937-45, 1996
                                                                                  30. Su CY et al: Perineural invasion of the trigeminal nerve in patients with nasopharyngeal carcinoma. Imaging and clinical correlations. Cancer. 78(10):2063-9, 1996
                                                                                  31. Schifter M et al: Perineural spread of squamous cell carcinoma involving trigeminal and facial nerves. Oral Surg Oral Med Oral Pathol. 75(5):587-90, 1993
                                                                                  32. Parker GD et al: Clinical-radiologic issues in perineural tumor spread of malignant diseases of the extracranial head and neck. Radiographics. 11(3):383-99, 1991
                                                                                  33. Laine FJ et al: Perineural tumor extension through the foramen ovale: evaluation with MR imaging. Radiology. 174(1):65-71, 1990