Pathology of the skull base, though not common, is often associated with high morbidity and mortality, especially in an elderly population. Clinically, it is a difficult area to assess, and findings are often nonspecific. This makes imaging an indispensable tool in the management of the disease and requires a thorough understanding by clinicians and radiologists alike. Pathological lesions can be divided into broad categories such as infection and inflammation, trauma, tumors, and osseous conditions. Unfortunately, a great deal of overlap exists in the radiological findings of these conditions, and often subspecialty expertise and close clinical corroboration are needed to narrow down the differential diagnoses. In most cases, computed tomography will suffice to come to a relatively confident diagnosis, assessment of disease extent, and follow-up. Magnetic resonance imaging should be reserved for specific problem-solving and assessment of complications. A good grasp of skull base imaging anatomy and pathological findings is essential in delivering timely diagnosis and intervention.