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Lea Alhilali, MD

@teachplaygrub

Mar 15, 2023 • 8 tweets • 5 min read • Read on X

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1/I call the skullbase “homebase” bc you can’t make an anatomy homerun without it!

Most know the arteries of the skullbase, but few know the veins. Do you?

Here’s a🧵to help you remember #skullbase venous #anatomy!
#medtwitter #meded #neurorad #radtwitter #neurosurgery #radres

2/When I look at the skullbase veins, I see an angry Santa yelling at me. His eyebrows are raised, his mouth is open, & he has a mustache w/a big beard hanging down.

Each I look at the skullbase, I look for this Santa—bc each part of him is an important venous structure.

3/So let’s start w/Santa’s eyes. The eyes are actually not a venous structure, but an important landmark—foramen ovale, where the V3 trigeminal nerve exit.

I remember ovale is Santa's eyes bc eyes are OVAL, so his eyes are OVALE

4/Next are Santa’s angry raised eyebrows. These are the sphenoparietal sinuses.

I remember these are the eyebrows bc I call them “seen”-oparietal sinuses & you see w/your eyes.

These have this “eyebrow” shape bc they are following the curve of the greater sphenoid wing

5/Sphenoparietal sinuses meet in the middle at the cavernous sinus—like your eyebrows meet in the middle at your nose.

I remember the cavernous sinus & intracavernous sinuses are Santa’s nose bc you dig in a cavern. And where do all kids like to go digging? Their nose! 🤢

6/Right below Santa’s nose is his mustache & this is the basilar plexus, right below the cavernous sinus.

You can remember this bc mustaches are made of a base & handlebars—and the BASE of Santa’s mustache is the BASilar plexus

7/Extending from Santa’s mustache is his beard. These are the petrosal sinuses (inferior & superior), important in many neurosurgical approaches.

You can remember that the PETROsal sinuses make up sides of the beard bc you use PETROleum to smooth the sides of your beard

8/Finally, Santa’s mouth is the marginal sinus. I remember this bc the word marginal sounds like “Aaaargh”—the sound pirates make from their mouth. I call it the Maaaargh—inal sinus

So hopefully this thread has given you some ELF-confidence when it comes to skullbase anatomy!

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More from @teachplaygrub

Lea Alhilali, MD

@teachplaygrub

Oct 15

1/”That’s a ninja turtle looking at me!” I exclaimed. My fellow rolled his eyes at me, “Why do I feel I’m going to see this a thread on this soon…”

He was right! A thread about one of my favorite imaging findings & pathology behind it

2/Now the ninja turtle isn’t an actual sign—yet!

But I am hoping to make it go viral as one. To understand what this ninja turtle is, you have to know the anatomy.

I have always thought the medulla looks like a 3 leaf clover in this region.

The most medial bump of the clover is the medullary pyramid (motor fibers).

Next to it is the inferior olivary nucleus (ION), & finally, the last largest leaf is the inferior cerebellar peduncle.

Now you can see that the ninja turtle eyes correspond to the ION.

3/But why are IONs large & bright in our ninja turtle?

This is hypertrophic olivary degeneration.

It is how ION degenerates when input to it is disrupted. Input to ION comes from a circuit called the triangle of Guillain & Mollaret—which sounds like a fine French wine label!

Read 9 tweets

Lea Alhilali, MD

@teachplaygrub

Oct 10

1/I always say you can tell a bad read on a spine MR if it doesn’t talk about lateral recesses.

What will I think when I see your read? Do you rate lateral recess stenosis?

Here’s a thread on lateral recess anatomy & a grading system for lateral recess stenosis

2/First anatomy.

Thecal sac is like a highway, carrying the nerve roots down the lumbar spine.

Lateral recess is part of the lateral lumbar canal, which is essentially the exit for spinal nerve roots to get off the thecal sac highway & head out into the rest of the body

3/Exits have 3 main parts.

First is the deceleration lane, where the car slows down as it starts the process of exiting.

Then there is the off ramp itself, and this leads into the service road which takes the car to the roads that it needs to get to its destination

Read 21 tweets

Lea Alhilali, MD

@teachplaygrub

Oct 8

1/Remembering spinal fracture classifications is back breaking work!

A thread to review the scoring system for thoracic & lumbar fractures—“TLICS” to the cool kids!

2/TLICS scores a fx on (1) morphology & (2) posterior ligamentous complex injury

Let's start w/morphology

TLICS scores severity like the steps to make & eat a pizza:

Mild compression (kneading), strong compression (rolling), rotation (tossing), & distraction (tearing in)

3/At the most mild, w/only mild axial loading, you get the simplest fx, a compression fx—like a simple long bone fx--worth 1 pt.

This is like when you just start to kneading the dough. There's pressure, but not as much as with a rolling pin!

Read 13 tweets

Lea Alhilali, MD

@teachplaygrub

Oct 6

1/Does PTERYGOPALATINE FOSSA anatomy feel as confusing as its spelling?

Does it seem to have as many openings as letters in its name?

Are you pterrified of the pterygopalatine fossa (PPF)?

Let this thread on PPF anatomy help you out.

2/The PPF is a crossroads between the skullbase & the extracranial head and neck

There are 4 main regions that meet here:

(1) Skullbase itself posteriorly, (2) nasal cavity medially, (3) infratemporal fossa laterally, and (4) orbit anteriorly.

3/At its most basic, you can think of the PPF as a room with 4 doors opening to each of these regions: one posteriorly to the skullbase, one medially to the nasal cavity, one laterally to the infratemporal fossa, and one anteriorly to the orbit

Read 18 tweets

Lea Alhilali, MD

@teachplaygrub

Oct 3

1/”Tell me where it hurts.”

How back pain radiates can tell a lot you about where the lesion is—if you know where to look!

Here’s how to remember lumbar radicular pain distributions!

2/Let’s start with L1. L1 radiates to the groin. I remember that b/c the number 1 is, well, um…phallic. So the phallic number 1 radiates to the groin.

3/Let’s skip to L3 for a second. I remember L3 is to the knee—easy, it rhymes!

Read 8 tweets

Lea Alhilali, MD

@teachplaygrub

Sep 19

1/Ready for a throw down?

MMA fights get a lot of attention, but MMA (middle meningeal art) & dural blood supply doesn’t get the attention it deserves.

A thread on dural vascular anatomy!

2/Everyone knows about the blood supply to the brain.

Circle of Willis anatomy is king and loved by everyone, while the vascular anatomy of the blood supply to the dura is the poor, wicked step child of vascular anatomy that is often forgotten

3/But dural vascular anatomy & supply are important, especially now that MMA embolizations are commonly for chronic recurrent subdurals.

It also important for understanding dural arteriovenous fistulas as well.

Read 17 tweets

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