Perineural Tumor Spread

      Perineural spread (PNS) refers to the extent of tumor cells or other nonneoplastic lesions along the tissues of the nerve sheath, its overall incidence ranges from 2.5% to 5%. PNS is more frequently associated with carcinoma arising from minor or major salivary glands (more often adenoid cystic carcinoma), mucosal or cutaneous squamous cell carcinoma, basal cell carcinoma, melanoma, lymphoma, and sarcoma. Although PNS was previously associated with worsening prognosis, increasing evidence shows that cure is possible. Therefore, radiologists must be aware of the relevant cranial nerve anatomy and thoroughly scrutinize not only the nerves close to the primary tumor site but also the whole neural pathways that can be accessed by PNS. Equally critical is knowledge of the radiologic appearance of perineural tumor extension and the best imaging strategies to detect PNS.

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      References

        • Mendenhall W.M.
        • Amdur R.J.
        • Williams L.S.
        • et al.
        Carcinoma of the skin of the head and neck with perineural invasion.
        Head Neck. 2002; 24: 78-83
        • Zupi A.
        • Mangone G.M.
        • Piombino P.
        • et al.
        Perineural invasion of the lower alveolar nerve by oral cancer: a follow-up study of 12 cases.
        J Craniomaxillofac Surg. 1998; 26: 318-321
        • Williams L.S.
        • Mancuso A.A.
        • Mendenhall W.M.
        Perineural spread of cutaneous squamous and basal cell carcinoma: CT and MR detection and its impact on patient management and prognosis.
        Int J Radiat Oncol Biol Phys. 2001; 49: 1061-1069
        • Galloway T.J.
        • Morris C.G.
        • Mancuso A.A.
        • et al.
        Impact of radiographic findings on prognosis for skin carcinoma with clinical perineural invasion.
        Cancer. 2005; 103: 1254-1257
        • Curtin H.D.
        Detection of perineural spread: fat suppression versus no fat suppression.
        AJNR Am J Neuroradiol. 2004; 25: 1-3
        • Fowler B.Z.
        • Crocker I.R.
        • Johnstone P.A.
        Perineural spread of cutaneous malignancy to the brain: a review of the literature and five patients treated with stereotactic radiotherapy.
        Cancer. 2005; 103: 2143-2153
        • Garden A.S.
        • Weber R.S.
        • Morrison W.H.
        • et al.
        The influence of positive margins and nerve invasion in adenoid cystic carcinoma of the head and neck treated with surgery and radiation.
        Int J Radiat Oncol Biol Phys. 1995; 32: 619-626
        • Hutcheson J.A.
        • Vural E.
        • Korourian S.
        • et al.
        Neural cell adhesion molecule expression in adenoid cystic carcinoma of the head and neck.
        Laryngoscope. 2000; 110: 946-948
        • Gandour-Edwards R.
        • Kapadia S.B.
        • Barnes L.
        • et al.
        Neural cell adhesion molecule in adenoid cystic carcinoma invading the skull base.
        Otolaryngol Head Neck Surg. 1997; 117: 453-458
        • Iwamoto S.
        • Odland P.B.
        • Piepkorn M.
        • et al.
        Evidence that the p75 neurotrophin receptor mediates perineural spread of desmoplastic melanoma.
        J Am Acad Dermatol. 1996; 35: 725-731
        • Miknyoczki S.J.
        • Klein-Szanto A.J.
        • Ruggeri B.A.
        Neurotrophin-Trk receptor interactions in neoplasia: a possible role in interstitial and perineural invasion in ductal pancreatic cancer.
        Crit Rev Oncog. 1996; 7: 89-100
        • Kalina P.
        • Bevilacqua P.
        Perineural extension of facial melanoma.
        Neuroradiology. 2005; 47: 372-374
        • Chang P.C.
        • Fischbein N.J.
        • McCalmont T.H.
        • et al.
        Perineural spread of malignant melanoma of the head and neck: clinical and imaging features.
        AJNR Am J Neuroradiol. 2004; 25: 5-11
        • Lo J.S.
        • Snow S.N.
        • Reizner G.T.
        • et al.
        Metastatic basal cell carcinoma: report of twelve cases with a review of the literature.
        J Am Acad Dermatol. 1991; 24: 715-719
        • Blandino A.
        • Gaeta M.
        • Minutoli F.
        • et al.
        CT and MR findings in neoplastic perineural spread along the vidian nerve.
        Eur Radiol. 2000; 10: 521-526
        • Ginsberg L.E.
        • De Monte F.
        • Gillenwater A.M.
        Greater superficial petrosal nerve: anatomy and MR findings in perineural tumor spread.
        AJNR Am J Neuroradiol. 1996; 17: 389-393
        • Schmalfuss I.M.
        • Tart R.P.
        • Mukherji S.
        • et al.
        Perineural tumor spread along the auriculotemporal nerve.
        AJNR Am J Neuroradiol. 2002; 23: 303-311
        • Majoie C.B.
        • Hulsmans F.J.
        • Verbeeten Jr., B.
        • et al.
        Perineural tumor extension along the trigeminal nerve: magnetic resonance imaging findings.
        Eur J Radiol. 1997; 24: 191-205
        • Chong V.F.
        • Fan Y.F.
        Hypoglossal nerve palsy in nasopharyngeal carcinoma.
        Eur Radiol. 1998; 8: 939-945
        • Streams B.N.
        • Eaton J.S.
        • Zelac D.E.
        Perineural spread of squamous cell carcinoma involving the spinal accessory nerve in an immunocompromised organ transplant recipient.
        Dermatol Surg. 2005; 31: 599-601
        • Ginsberg L.E.
        • Eicher S.A.
        Great auricular nerve: anatomy and imaging in a case of perineural tumor spread.
        AJNR Am J Neuroradiol. 2000; 21: 568-571
        • Erbay S.H.
        • Bhadelia R.A.
        • O'Callaghan M.
        • et al.
        Nerve atrophy in severe trigeminal neuralgia: noninvasive confirmation at MR imaging–initial experience.
        Radiology. 2006; 238: 689-692
        • Ginsberg L.E.
        MR imaging of perineural tumor spread.
        Magn Reson Imaging Clin N Am. 2002; 10: 511-525
        • Lau C.H.
        • Taylor S.
        The eye in malignant disease.
        Hosp Med. 2003; 64: 177-179
        • McNab A.A.
        • Francis I.C.
        • Benger R.
        • et al.
        Perineural spread of cutaneous squamous cell carcinoma via the orbit. Clinical features and outcome in 21 cases.
        Ophthalmology. 1997; 104: 1457-1462
        • Boerman R.H.
        • Maassen E.M.
        • Joosten J.
        • et al.
        Trigeminal neuropathy secondary to perineural invasion of head and neck carcinomas.
        Neurology. 1999; 53: 213-216
        • Bridgman J.B.
        • Snape L.
        Facial sensory loss—a need for suspicion.
        N Z Dent J. 1998; 94: 65-68
        • Slavin M.L.
        • Abramson A.L.
        Squamous cell carcinoma of the pterygopalatine fossa (retroantral space).
        J Clin Neuroophthalmol. 1986; 6: 254-257
        • Dolan E.J.
        • Schwartz M.L.
        • Lewis A.J.
        • et al.
        Adenoid cystic carcinoma: an unusual neurosurgical entity.
        Can J Neurol Sci. 1985; 12: 65-68
        • Ariji Y.
        • Fuwa N.
        • Tachibana H.
        • et al.
        Denervation atrophy of the masticatory muscles in a patient with nasopharyngeal cancer: MR examinations before and after radiotherapy.
        Dentomaxillofac Radiol. 2002; 31: 204-208
        • Gray H.
        • Williams P.L.
        • Bannister L.H.
        Gray's anatomy: the anatomical basis of medicine and surgery.
        38th edition. Churchill Livingstone, New York1995
        • Harris C.P.
        • Baringer J.R.
        The numb chin in metastatic cancer.
        West J Med. 1991; 155: 528-531
        • Selesnick S.H.
        • Burt B.M.
        Regional spread of nonneurogenic tumors to the skull base via the facial nerve.
        Otol Neurotol. 2003; 24: 326-333
        • Silvester K.C.
        • Barnes S.
        Adenoid cystic carcinoma of the tongue presenting as a hypoglossal nerve palsy.
        Br J Oral Maxillofac Surg. 1990; 28: 122-124
        • Ziyal I.M.
        • Sekhar L.N.
        • Ozgen T.
        • et al.
        The trigeminal nerve and ganglion: an anatomical, histological, and radiological study addressing the transtrigeminal approach.
        Surg Neurol. 2004; 61 ([discussion: 73–4]): 564-573
        • Williams L.S.
        • Schmalfuss I.M.
        • Sistrom C.L.
        • 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. 2003; 24: 1317-1323
        • Yousry I.
        • Moriggl B.
        • Schmid U.D.
        • et al.
        Trigeminal ganglion and its divisions: detailed anatomic MR imaging with contrast-enhanced 3D constructive interference in the steady state sequences.
        AJNR Am J Neuroradiol. 2005; 26: 1128-1135
        • Caruso R.D.
        • Rosenbaum A.E.
        • Chang J.K.
        • et al.
        Craniocervical junction venous anatomy on enhanced MR images: the suboccipital cavernous sinus.
        AJNR Am J Neuroradiol. 1999; 20: 1127-1131
        • Voyvodic F.
        • Whyte A.
        • Slavotinek J.
        The hypoglossal canal: normal MR enhancement pattern.
        AJNR Am J Neuroradiol. 1995; 16: 1707-1710
        • Martin-Duverneuil N.
        • Sola-Martinez M.T.
        • Miaux Y.
        • et al.
        Contrast enhancement of the facial nerve on MRI: normal or pathological?.
        Neuroradiology. 1997; 39: 207-212
        • Maroldi R.
        • Nicolai P.
        Imaging in treatment planning for sinonasal diseases.
        Springer, Berlin2005 (New York)
        • Maravilla K.R.
        • Bowen B.C.
        Imaging of the peripheral nervous system: evaluation of peripheral neuropathy and plexopathy.
        AJNR Am J Neuroradiol. 1998; 19: 1011-1023
        • Nemzek W.R.
        • Hecht S.
        • Gandour-Edwards R.
        • et al.
        Perineural spread of head and neck tumors: how accurate is MR imaging?.
        AJNR Am J Neuroradiol. 1998; 19: 701-706
        • Carter R.L.
        • Foster C.S.
        • Dinsdale E.A.
        • et al.
        Perineural spread by squamous carcinomas of the head and neck: a morphological study using antiaxonal and antimyelin monoclonal antibodies.
        J Clin Pathol. 1983; 36: 269-275
        • Kobayashi S.
        • Yoshizawa H.
        • Hachiya Y.
        • et al.
        Vasogenic edema induced by compression injury to the spinal nerve root. Distribution of intravenously injected protein tracers and gadolinium-enhanced magnetic resonance imaging.
        Spine. 1993; 18: 1410-1424
        • Sartoretti-Schefer S.
        • Wichmann W.
        • Valavanis A.
        Idiopathic, herpetic, and HIV-associated facial nerve palsies: abnormal MR enhancement patterns.
        AJNR Am J Neuroradiol. 1994; 15: 479-485
        • Caldemeyer K.S.
        • Mathews V.P.
        • Righi P.D.
        • et al.
        Imaging features and clinical significance of perineural spread or extension of head and neck tumors.
        Radiographics. 1998; 18 ([quiz: 47]): 97-110
        • Ginsberg L.E.
        • DeMonte F.
        Imaging of perineural tumor spread from palatal carcinoma.
        AJNR Am J Neuroradiol. 1998; 19: 1417-1422
        • Barakos J.A.
        • Dillon W.P.
        • Chew W.M.
        Orbit, skull base, and pharynx: contrast-enhanced fat suppression MR imaging.
        Radiology. 1991; 179: 191-198
        • Maroldi R.
        • Ambrosi C.
        • Farina D.
        Metastatic disease of the brain: extra-axial metastases (skull, dura, leptomeningeal) and tumour spread.
        Eur Radiol. 2005; 15: 617-626
        • Williams L.S.
        Advanced concepts in the imaging of perineural spread of tumor to the trigeminal nerve.
        Top Magn Reson Imaging. 1999; 10: 376-383
        • Blandino A.
        • Gaeta M.
        • Volta S.
        • et al.
        Perineural metastatic spread along the infraorbital nerve in malignant neoplasms of the skin. Findings with computerized tomography and magnetic resonance in 2 cases.
        Radiol Med (Torino). 1995; 90: 129-131
        • Curtin H.D.
        • Williams R.
        • Johnson J.
        CT of perineural tumor extension: pterygopalatine fossa.
        AJR Am J Roentgenol. 1985; 144: 163-169
        • Parker G.D.
        • Harnsberger H.R.
        Clinical-radiologic issues in perineural tumor spread of malignant diseases of the extracranial head and neck.
        Radiographics. 1991; 11: 383-399
        • Woodruff Jr., W.W.
        • Yeates A.E.
        • McLendon R.E.
        Perineural tumor extension to the cavernous sinus from superficial facial carcinoma: CT manifestations.
        Radiology. 1986; 161: 395-399
        • Pandolfo I.
        • Gaeta M.
        • Blandino A.
        • et al.
        Perineural spread of nasopharyngeal carcinoma: radiological and CT demonstration.
        Eur J Radiol. 1988; 8: 231-235
        • Laine F.J.
        • Braun I.F.
        • Jensen M.E.
        • et al.
        Perineural tumor extension through the foramen ovale: evaluation with MR imaging.
        Radiology. 1990; 174: 65-71
        • Fischbein N.J.
        • Kaplan M.J.
        • Jackler R.K.
        • et al.
        MR imaging in two cases of subacute denervation change in the muscles of facial expression.
        AJNR Am J Neuroradiol. 2001; 22: 880-884
        • Russo C.P.
        • Smoker W.R.
        • Weissman J.L.
        MR appearance of trigeminal and hypoglossal motor denervation.
        AJNR Am J Neuroradiol. 1997; 18: 1375-1383
        • Davis S.B.
        • Mathews V.P.
        • Williams 3rd, D.W.
        Masticator muscle enhancement in subacute denervation atrophy.
        AJNR Am J Neuroradiol. 1995; 16: 1292-1294