ARRS 2022 Abstracts

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E2118. Case-Based Imaging Review of Posterior Fossa Tumors in Adults and Children
Authors
  1. Issa Khoury; Montefiore Medical Center
  2. Jacqueline Bello; Montefiore Medical Center
  3. Keivan Shifteh; Montefiore Medical Center
Background
Infratentorial brain tumors can be seen in children and adults. In children, the tumors may arise from three different locations: brainstem, cerebellum, and fourth ventricle. In adults, the tumors can arise either extra-axially or intra-axially. The purpose of this exhibit is to provide a systematic approach of evaluating different posterior fossa tumors for the adult and pediatric population. We will review posterior fossa anatomy, as well as unique imaging characteristics of posterior fossa tumors on CT and MRI. In addition, management and prognosis will be discussed during several cases.

Educational Goals / Teaching Points
The goals of this exhibit are to review the posterior fossa anatomy; discuss the differential diagnosis of posterior fossa tumors in both adults and children; understand epidemiology and prevalence of different posterior fossa tumors for the adult and pediatric population; and identify the characteristic imaging appearance of posterior fossa tumors on CT and MRI.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A review of the anatomy of the posterior fossa will be discussed. We will establish a differential of posterior fossa tumors based on 1) age (adults vs children) and 2) location (brainstem, cerebellum, or fourth ventricle in children or extra-axial vs intra-axial in adults). We will utilize a case-based approach to each diagnosis, including clinical information, epidemiology, and imaging findings with CT and MRI examples. Cases in the pediatric population include pilocytic astrocytoma, medulloblastoma, ependymoma, ATRT, hemangioblastoma, and teratoma. Cases in the adult population include metastasis, hemangioblastoma, astrocytoma, medulloblastoma, ependymoma, lymphoma, leukemia, epidermoid tumor, and lipoma. In addition, management and prognosis will be discussed during several cases.

Conclusion
Masses of the posterior fossa can be difficult to differentiate from one another clinically. As such, radiologic imaging such as CT and MRI play an important role in differentiating these lesions. It is crucial to establish a diagnostic algorithm and follow a structured approach when assessing posterior fossa masses. By using parameters such as patient age and anatomic location of pathology, we can adequately narrow down larger differentials and help guide diagnosis. Today, with the combined modalities of surgery, radiation therapy, and chemotherapy, long-term survival is the norm in several of these tumors, further exemplifying the importance of an accurate diagnosis.