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Mohammed issa al-oqaily

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The inside view of cranium is known as

cranial cavity
The cranial cavity contains
the brain and its surrounding
meninges, portions of the
cranial nerves, arteries,
veins, and venous sinuses.
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Bones that make up the cranial cavity

Cranial cavity is contained by the

frontal, parietal, sphenoid,
temporal and occipital bones, and
in part the ethmoid, all covered by
endosteal layer of dura mater

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Anatomy of the lateral aspects of the skull

Parietal bone
Coronal suture
Frontal bone
Temporal Sphenoid bone
bone (greater wing)
Frontal sinus
Crista galli
Lambdoid suture Nasal bone
Occipital Sphenoid sinus
bone Ethmoid bone
Occipitomastoid (perpendicular plate)
suture Vomer bone
External occipital Incisive fossa
protuberance Maxilla
Alveolar margins
Internal acoustic
Sella turcica Mandible
process of
of sphenoid
(b) sphenoid Mandibular Palatine
bone foramen bone Palatine
process of
The cranial cavity is divided into three
cranial fossa

1. Anterior cranial fossa which accommodates the

anterior lobe of brain.

2. Middle cranial fossa, much wider than the anterior

cranial fossa contain the 2 temporal lobes of brain.

3. Posterior cranial fossa is much shallower and wider

than the middle cranial fossa and it accommodates the
occipital lobes of the brain.
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Posterior cranial fossa

•Itis the deepest and most capacious of the 3

cranial fossae.

contains the cerebellum, pons, and medulla
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❂ The foramen magnum is located centrally

and inferiorly in the posterior fossa. The
posterior fossa is surrounded by deep
grooves containing the transverse sinuses
and sigmoid sinuses

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Superior border of the petrous part of temporal bone
and dorsum sallae.

Internal surface of squamous part of the occipital bone.

Basilar, squamous & condylor parts of the occipital
bone & mastoid part
foramen magnum forms the central part of the floor.
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.Figure 7.4b-c: Anatomy of the inferior portion of the skull, p. 208

Olfactory foramina Frontal bone

Anterior cranial fossa Cribriform plate
Crista galli
Lesser wing
Sphenoid Optic canal
Greater wing
Anterior clinoid process
Tuberculum sellae Foramen rotundum
Hypophyseal fossa Foramen ovale
Sella Dorsum sellae
turcica Posterior clinoid process Foramen spinosum
Middle cranial
fossa Foramen lacerum
Temporal bone Jugular foramen
(petrous part)
Hypoglossal canal
acoustic meatus
Posterior Anterior
cranial fossa cranial
Parietal bone fossa

Occipital bone Middle

(b) Foramen magnum fossa

Tumors of the
posterior cranial

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❂ Tumors in the posterior fossa are
considered critical brain lesions. This is,
primarily, because of the limited space
within the posterior fossa and the potential
involvement of vital brain stem nuclei.

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❂ Posterior fossa tumors are more common

in children than the adults.
❂ Between 54% and 70% of all childhood
brain tumors originate in the posterior
❂ About 15-20% of brain tumors in adults
occur in the posterior fossa
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❂ Certain types of posterior fossa tumors,
such as medulloblastoma, pineoblastoma,
ependymomas, primitive neuroectodermal
tumors (PNETs), and astrocytomas of the
cerebellum and brain stem, occur more
frequently in children.

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❂ Some glial tumors, such as mixed gliomas,

are unique to children. They are located
more frequently in the cerebellum (67%)
and are usually benign.

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❂ No specific causes for posterior fossa tumors

exist. However, genetic factors, such as
dysfunction of some tumor suppressor genes
(p53 gene) and activation of some
oncogenes, may play a role in their
development.2 Environmental factors such as
irradiation and toxins may also play a role.

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types of
fossa tumors
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Cerebellar astrocytoma

❂ Cystic cerebellar astrocytoma comprises

about 33% of all posterior fossa tumors in
children. It represents 25% of all pediatric
tumors. Average age at presentation is 9

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❂ Typically, cerebellar astrocytoma presents as a

laterally located cyst with a well-defined solid
component. The tumor may be solid or cystic
and may be located medially in the vermis or
laterally in the cerebellar hemisp.

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Primary neuroectodermal tumors

❂ PNETs include medulloblastomas,

medulloepitheliomas, pigmented
medulloblastomas, ependymoblastomas,
pineoblastomas, and cerebral neuroblastomas.

❂ These tumors originate from undifferentiated cells

in the subependymal region in the fetal brain.
PNETs are second to the cerebellar astrocytoma in
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❂ Medulloblastoma initially arises in the

inferior medullary velum and grow to fill
the fourth ventricle, infiltrating the
surrounding structures. Some erroneously
thought it arose from medulloblast cells,
which do not exist.

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Ependymoma and ependymoblastoma

❂ Ependymomas are derived from ependymal

cells. They occur more frequently in females,
with 50% presenting in children younger than 3

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❂ An ependymoma has a much better

prognosis than an anaplastic ependymomas
(ependymoblastoma). Plastic ependymoma
can mold itself to the available spaces
inside or outside the ventricle without
adhering to the ventricle.

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Choroid plexus papilloma and carcinoma

❂ Choroid plexus papilloma and carcinoma

represent 0.4-0.6% of all intracranial tumors.
❂ They are more frequent in children than in
adults (3% of childhood brain tumors).
❂ Sixty percent occur in the lateral ventricle
and 30% in the fourth ventricle. The third
ventricle and cerebellopontine angle are rare
locations for this tumor.
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❂ Cerebrospinal fluid (CSF) overproduction

may occur, sometimes reaching more than 4
times normal volumes.
❂ In most of cases, CSF analysis demonstrates
increased protein, xanthochromia, or both.

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Brainstem gliomas

❂ Brainstem gliomas constitute 15% of all

brain tumors.
❂ In children, brainstem glioma represents
25-30% of all brain tumors.
❂ Most brainstem gliomas are low-grade

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Other tumors

❂ Dermoid tumors

❂ Hemangioblastoma

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Dermoid tumors

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Metastatic tumors

❂ Three percent of all

cranial metastatic lesions
occur in the brainstem
and 18% occur in the
❂ Originating sites include
breast, lung, skin, and
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❂ The clinical presentation depends on the site

of the tumor, biological behavior and
aggressiveness of the tumor, and the rate of
❂ At the time of presentation, the patient may
be very ill from severe headache or frequent
vomiting due to associated hydrocephalus.

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❂ Symptoms may be caused by focal

compression of the cerebellum or brain
stem centers and increased intracranial

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❂ Symptoms due to focal brainstem

compression include cranial nerve
❂ This commonly involves the nuclei or tracts
of the third, fourth, or sixth cranial nerves,
resulting in ocular palsies and diplopia and
long tract signs (hemiparesis).

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❂ Symptoms due to focal compression of the

cerebellum include characteristic eye
findings and vermian syndrome.

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Outcome and Prognosis

❂ The 5-year survival rates exceed 60% for

all patients and 80% for certain good-risk
individuals with posterior fossa tumors.

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❂ Posterior Fossa Tumors

❂ Author: Hassan Ahmad Hassan Al-

❂ Coauthor(s): Ayman Ali Galhom
❂ Herbert H Engelhard III

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