A complete clinical and neurologic examination should be done in each patient affected by skull base pathologies.

Brain Involvement

Tumoral compression or infiltration of the brain, hemorrhages, and contusions/lacerations should be investigated, as they can affect frontal, temporal, and occipital lobe function. The long pathways (motor and sensory system), cranial nerves and brainstem reflexes should be carefully examined.

Clinical Features

Middle Skull Base

Central/Paracentral

• Optic neuropathy (check for optic nerve and chiasm dysfunctions), cavernous sinus syndromes (ophthalmoparesis, trigeminal pain, etc.).

• Check for pituitary/hypothalamus involvement.

• Check for vascular involvement (arterial dissection, traumatic aneurysms, iatrogenic pseudoaneurysms, carotid-cavernous fistula).

Lateral

• Trigeminal dysfunctions (dysesthesia, pain, anesthesia), chewing deficits trismus

• Proptosis, epistaxis

Cerebellopontine Angle/Jugular Foramen

• Cranial nerve involvement: all the neurologic deficits related to dysfunction of cranial nerves (CNs) III to XII

• Brainstem corticospinal findings

• Cerebellar findings

Clivus

• Uni/bilateral cranial neuropathies (e.g., CNs III to VI palsies)

• Vertebrobasilar system-related deficits

Foramen Magnum

• Brainstem findings (e.g., rotating and progressive weakness, alternate syndromes)

• CNs XI and XII palsies.

• Suboccipital neck pain

Craniocervical Junction

• Brainstem/spinal cord findings

• Craniocervical instability, occipital/suboccipital pain

Anterior Skull Base