Introduction

Primary (direct) or secondary (indirect) traumatic injuries of brain structures localized within the posterior fossa (i.e., cerebellum and brainstem) are called ‘posterior fossa trauma’ (Fisher et al., 1958 Tsai et al., 1980).Primary traumatic injuries are commonly subdivided into open/closed head injuries, and intra-/extra-axial lesions. Open head injuries are characterized by opening of the subarachnoid space to the outside with liquorrhea, and are caused by penetrating injuries or by fractures. In closed head injuries the subarachnoid space remains intact. Intra-axial brain lesions lead to intraparenchymal damage, namely cerebellar or brainstem concussion and contusion, diffuse axonal injury due to shearing forces and delayed post-traumatic intracerebellar hematomas. Extra-axial injuries include epidural hematomas, subdural hematomas, and subarachnoid hemorrhages. Furthermore, vascular lesions may occur due to traumatic dissection of the vertebral arteries with subsequent infarction of the cerebellum and/or brainstem. Secondary traumatic brain lesions develop after the primary impact and are usually due to pathologic brain responses to the primary injury (e.g., brain edema, infection, elevated intracranial pressure, brain herniation) (Zimmerman, 1991 Keidel and Miller, 1996).

Despite advances in the understanding of the pathophysiology of primary and secondary brain injuries and in the management of patients with severe head trauma, posterior fossa trauma remains a life-threatening condition, which allows no delay in diagnosis and management. This chapter gives an overview of types, clinical and radiological presentation of posterior fossa trauma. The chapter also describes the pathophysiology and management of posterior fossa trauma. Special operative techniques are not described.