Lea Alhilali, MD Profile picture
Mar 15, 2023 8 tweets 5 min read Read on X
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 Image
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. Image
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 Image
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 Image
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! 🤢 Image
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 Image
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 Image
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! Image

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More from @teachplaygrub

Jan 31
1/Can’t remember what to look for on scans for memory loss?

New Alzheimer’s treatments are changing these scans!

Read on for the latest @theAJNR SCANtastic on imaging in AD:

ajnr.org/content/early/Image
2/Current hypothesis in Alzheimer’s disease (AD) is that accumulation of amyloid beta (AB) protein result sin inflammation & neuronal death

Thus, new treatments in AD are focused on anti-AB antibodies that remove this protein in AD patients. Image
3/However, AB protein is also deposited in vessel walls in AD pts—just like in cerebral amyloid
angiopathy

So removing it from vessel walls increases vascular permeability, leading to edema & hemorrhage

Think of it like how a baby gets mad when you take its candy away! Image
Read 15 tweets
Jan 31
1/Can’t remember what to look for on scans for memory loss?

New Alzheimer’s treatments are changing the way we look at these scans!

Read on to get up to date w/the latest @theAJNR SCANtastic on imaging for Alzheimer’s Disease:

ajnr.org/content/early/…Image
@TheAJNR 2/Current hypothesis in Alzheimer’s disease (AD) is that accumulation of amyloid beta (AB) protein result sin inflammation & neuronal death

Thus, new treatments in AD are focused on anti-AB antibodies that remove this protein in AD patients. Image
@TheAJNR 3/However, AB protein is also deposited in vessel walls in AD pts—just like in cerebral amyloid angiopathy

So removing it from vessel walls increases vascular permeability, leading to edema & hemorrhage

Think of it like how a baby gets mad when you take its candy away! Image
Read 15 tweets
Dec 23, 2024
1/Does trying to figure out cochlear anatomy cause your head to spiral?

Hungry for some help?

Here’s a thread to help you untwist cochlear CT anatomy w/food analogies! Image
2/On axial temporal bone CT, you cannot see the whole cochlea at once. So let’s start at the bottom.

The first thing you come to is the basal turn of the cochlea (makes sense, basal=bottom). On axial images, it looks like a banana. I remember both Basal and Banana start w/B. Image
3/As you move up to the next slice, you start to see the upper turns of the cochlea coming in above the basal turn. They look like a stack of pancakes.

Pancakes are the heart of any breakfast, so they are at the heart or middle of the cochlea on imaging. Image
Read 9 tweets
Dec 19, 2024
1/Talk about dangerous liaisons!

Abnormal brain vascular connections like a dural arteriovenous fistula (dural AVF) can be dangerous!

This month’s @theAJNR SCANtastic thread is here to you some durable knowledge about dural AVFs!

ajnr.org/content/45/12/…Image
2/Dural sinuses sit inside dural leaflets.

Arteries that feed the dura also feed the walls of sinuses, like vasa vasorum.

Arteries in the walls of veins are a natural connection between the veins and arteries—but these connections are usually closed in normal pts. Image
3/Whether these connections are open depends on pressure.

Like a hose w/a hole in it, at normal pressures, abnormal connections are not open.

But if pressure is increased w/thrombosis or stenosis, the connections open, like high pressure water squirting out through a hole. Image
Read 18 tweets
Dec 6, 2024
1/Time to FESS up! Do you understand functional endoscopic sinus surgery (FESS)?

If you read sinus CTs, you better know what the surgeon is doing or you won’t know what you’re doing!

Here’s a thread to make sure you always make the important findings! Image
2/The first step is to insert the endoscope into the nasal cavity.

The first two structures encountered are the nasal septum and the inferior turbinate. Image
3/So on every sinus CT you read, the first question is whether there is enough room to insert the scope.

Will it go in smoothly or will it be a tight fit? Image
Read 19 tweets
Dec 2, 2024
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! Image
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 Image
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. Image
Read 17 tweets

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