You are on page 1of 47

POSTEIOR CRANIAL

FOSSA

Mohammed issa al-oqaily


12/21/09
261100003 1
Mohammed issa al-oqaily 261100003 POSTEIOR
CRANIAL
2 12/21/09
Mohammed issa al-oqaily 261100003
3 12/21/09
POSTEIOR CRANIAL
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.
12/21/09 Mohammed issa al-oqaily 4
261100003 POSTEIOR
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

12/21/09 Mohammed issa al-oqaily 5


261100003 POSTEIOR
Anatomy of the lateral aspects of the skull

Parietal bone
Coronal suture
Squamous
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
meatus
Pterygoid
Sella turcica Mandible
process of
of sphenoid
(b) sphenoid Mandibular Palatine
bone foramen bone Palatine
bone
process of
maxilla
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.
12/21/09 Mohammed issa al-oqaily 7
261100003 POSTEIOR
Mohammed issa al-oqaily 261100003
8 12/21/09
POSTEIOR CRANIAL
Posterior cranial fossa

•Itis the deepest and most capacious of the 3


cranial fossae.

•It
contains the cerebellum, pons, and medulla
oblongata.
12/21/09 Mohammed issa al-oqaily 9
261100003 POSTEIOR
Mohammed issa al-oqaily 261100003
10 12/21/09
POSTEIOR CRANIAL
Continue . . .

❂ 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

12/21/09 Mohammed issa al-oqaily 11


261100003 POSTEIOR
Mohammed issa al-oqaily 261100003
12 12/21/09
POSTEIOR CRANIAL
Boundaries:

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

Posteriorly
Internal surface of squamous part of the occipital bone.

Floor
Basilar, squamous & condylor parts of the occipital
bone & mastoid part
foramen magnum forms the central part of the floor.
12/21/09 Mohammed issa al-oqaily 13
261100003 POSTEIOR
.Figure 7.4b-c: Anatomy of the inferior portion of the skull, p. 208

Olfactory foramina Frontal bone


Anterior cranial fossa Cribriform plate
Ethmoid
Crista galli
bone
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
Internal
acoustic meatus
Posterior Anterior
cranial fossa cranial
Parietal bone fossa

Occipital bone Middle


cranial
(b) Foramen magnum fossa

Posterior
cranial
fossa
(c)
Tumors of the
posterior cranial
fossa

Mohammed issa al-oqaily 261100003 POSTEIOR CRANIAL 12/21/09 16


❂ 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.

12/21/09 Mohammed issa al-oqaily 17


261100003 POSTEIOR
Frequency

❂ Posterior fossa tumors are more common


in children than the adults.
❂ Between 54% and 70% of all childhood
brain tumors originate in the posterior
fossa.
❂ About 15-20% of brain tumors in adults
occur in the posterior fossa
12/21/09 Mohammed issa al-oqaily 18
261100003 POSTEIOR
Continue . . .
❂ 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.

12/21/09 Mohammed issa al-oqaily 19


261100003 POSTEIOR
Continue . . .

❂ Some glial tumors, such as mixed gliomas,


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

12/21/09 Mohammed issa al-oqaily 20


261100003 POSTEIOR
Etiology

❂ 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.

12/21/09 Mohammed issa al-oqaily 21


261100003 POSTEIOR
Common
types of
posterior
fossa tumors
12/21/09
Mohammed issa al-oqaily 261100003 POSTEIOR CRANIAL 22
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
years.

12/21/09 Mohammed issa al-oqaily 23


261100003 POSTEIOR
Mohammed issa al-oqaily 261100003
24 12/21/09
POSTEIOR CRANIAL
Continue . . .

❂ 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.

12/21/09 Mohammed issa al-oqaily 25


261100003 POSTEIOR
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
frequency
12/21/09 Mohammed issa al-oqaily 26
261100003 POSTEIOR
Medulloblastoma

❂ 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.

12/21/09 Mohammed issa al-oqaily 27


261100003 POSTEIOR
Mohammed issa al-oqaily 261100003
28 12/21/09
POSTEIOR CRANIAL
Ependymoma and ependymoblastoma

❂ Ependymomas are derived from ependymal


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

12/21/09 Mohammed issa al-oqaily 29


261100003 POSTEIOR
30
Continue . . .

❂ 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.

12/21/09 Mohammed issa al-oqaily 31


261100003 POSTEIOR
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.
12/21/09 Mohammed issa al-oqaily 32
261100003 POSTEIOR
Continue . . .

❂ 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.

12/21/09 Mohammed issa al-oqaily 33


261100003 POSTEIOR
Mohammed issa al-oqaily 261100003
34 12/21/09
POSTEIOR CRANIAL
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
astrocytoma.

12/21/09 Mohammed issa al-oqaily 35


261100003 POSTEIOR
Mohammed issa al-oqaily 261100003
36 12/21/09
POSTEIOR CRANIAL
Other tumors

❂ Dermoid tumors

❂ Hemangioblastoma

12/21/09 Mohammed issa al-oqaily 37


261100003 POSTEIOR
Dermoid tumors

12/21/09 Mohammed issa al-oqaily 38


261100003 POSTEIOR
Hemangioblastoma

12/21/09 Mohammed issa al-oqaily 39


261100003 POSTEIOR
Metastatic tumors

❂ Three percent of all


cranial metastatic lesions
occur in the brainstem
and 18% occur in the
cerebellum.
❂ Originating sites include
breast, lung, skin, and
kidney.
12/21/09 Mohammed issa al-oqaily 40
261100003 POSTEIOR
Presentation

❂ The clinical presentation depends on the site


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

12/21/09 Mohammed issa al-oqaily 41


261100003 POSTEIOR
Continue . . .

❂ Symptoms may be caused by focal


compression of the cerebellum or brain
stem centers and increased intracranial
pressure.

12/21/09 Mohammed issa al-oqaily 42


261100003 POSTEIOR
Continue . . .

❂ Symptoms due to focal brainstem


compression include cranial nerve
dysfunction.
❂ 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).

12/21/09 Mohammed issa al-oqaily 43


261100003 POSTEIOR
Continue . . .

❂ Symptoms due to focal compression of the


cerebellum include characteristic eye
findings and vermian syndrome.

12/21/09 Mohammed issa al-oqaily 44


261100003 POSTEIOR
Outcome and Prognosis

❂ The 5-year survival rates exceed 60% for


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

12/21/09 Mohammed issa al-oqaily 45


261100003 POSTEIOR
References

❂ Posterior Fossa Tumors

❂ Author: Hassan Ahmad Hassan Al-


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

12/21/09 Mohammed issa al-oqaily 46


261100003 POSTEIOR
Mohammed issa al-oqaily 261100003
47 12/21/09
POSTEIOR CRANIAL