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Published online by Cambridge University Press: 10 July 2025
Background: Intracranial extension of temporomandibular joint (TMJ) lesions is uncommon and may lead to radiological misinterpretation. This review aimed to identify clinical and radiological features of these lesions and whether radiological misinterpretation contributed to delayed or incorrect intervention. Methods: A comprehensive search of MEDLINE, SCOPUS, and Embase identified 2,256 records. Studies with clinical and imaging details of TMJ lesions extending intracranially were included. Reviews and non-English studies were excluded. After screening, 113 studies involving 132 patients were included. Results: Patients had an average symptom duration of 32 months until diagnosis (47% female, mean age 50±15 years). The most common diagnoses were pigmented villonodular synovitis/tenosynovial giant cell tumor (46%) and synovial chondromatosis (24%). Neurological symptoms were reported in 48% of cases, most frequently hearing loss (35%). Diagnostic accuracy increased from 38% to 62% when both CT and MRI were used. Most lesions were non-enhancing on CT (85%) and MRI (74%), and demonstrated no edema (96%). In one case, a ganglion cyst was misdiagnosed as a cystic brain tumor, leading to neurosurgical resection. Conclusions: TMJ lesions extending intracranially have neurological symptoms in less than half of cases and demonstrate no enhancement or edema. Familiarity with these characteristics is essential to avoiding misdiagnoses and ensuring timely management.