History of the Procedure: Hippocrates, who likely performed it for headache, epilepsy, fractures, and blindness, first described trephination.

Cushing probably was the first to report a large series of posterior fossa tumors. He published information about 61 patients with cerebellar medulloblastoma with mostly fatal outcome.

Advances in brain surgery for tumors primarily were due to discovery of anesthesia, asepsis, and neurological localization.

Problem: 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.

Some patients should undergo an emergency operation, especially if they present with acute symptoms of brain stem involvement or herniation.

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.
• 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.
• Some glial tumors, such as mixed gliomas, are unique to children. They are located more frequently in the cerebellum (67%) and usually are benign.

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