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Cranial fossa

The cranial fossae are the three principal depressions that form the floor of the within the , comprising the anterior, middle, and posterior fossae, which collectively accommodate major portions of the and associated neurovascular structures. These fossae are formed by contributions from the frontal, ethmoid, sphenoid, temporal, and occipital bones, creating a compartmentalized that supports the brain's weight while facilitating the passage of , blood vessels, and dural reflections. The divisions are separated by bony ridges and dural septa, such as the and tentorium cerebelli, which help maintain structural integrity and prevent excessive brain displacement. The is the shallowest and most anterior division, bounded anteriorly and laterally by the , posteriorly by the lesser wings and limbus of the , and featuring the of the in its floor. It primarily houses the frontal lobes of the cerebral hemispheres and the olfactory bulbs, with key foramina including the (transmitting fibers, CN I), anterior and posterior ethmoidal foramina (for ethmoidal neurovascular bundles), and the foramen cecum (for a small vein). The middle cranial fossa, often described as butterfly-shaped, lies centrally and is formed mainly by the body and greater wings of the sphenoid bone along with the squamous and petrous parts of the temporal bones, bounded anteriorly by the lesser wings of the sphenoid, posteriorly by the dorsum sellae and petrous ridges, and laterally by the greater wings of the sphenoid and temporal squamae. It accommodates the temporal lobes of the brain, the pituitary gland within the sella turcica, the cavernous sinuses, and segments of the internal carotid arteries, while numerous foramina—such as the optic canal (CN II and ophthalmic artery), superior orbital fissure (CN III, IV, V1, VI), foramen rotundum (CN V2), foramen ovale (CN V3 and accessory meningeal artery), foramen spinosum (middle meningeal vessels), and carotid canal (internal carotid artery)—allow passage of critical neurovascular elements. The posterior cranial fossa is the largest and deepest compartment, formed predominantly by the with contributions from the petrous and mastoid parts of the temporal bones and the basilar part of the occipital, bounded anteriorly by the and clivus, laterally and posteriorly by the occipital and temporal bones, and inferiorly by the . It contains the , (including the medulla, , and ), and the , along with VII–XII and the vertebrobasilar arterial system, with major foramina such as the (spinal cord, vertebral arteries, CN XI), (CN IX–XI and ), (CN XII), and internal acoustic meatus (CN VII and VIII).

Introduction

Definition

The cranial fossae refer to the three principal, uneven depressions that form the floor of the , providing compartments for the basal portions of the . These fossae collectively create a molded surface that conforms to the inferior aspects of the cerebral hemispheres, , and , facilitating the stable positioning of these neural structures within the . The depressions are formed by contributions from several cranial bones, including the frontal, ethmoid, sphenoid, temporal, and occipital bones, which articulate to produce the irregular, paired contours of the base. The term "fossa," denoting a ditch or trench, originates from Latin fossa, derived from the verb fodere meaning "to dig," reflecting the excavated appearance of these bony concavities in anatomical descriptions. Functionally, the cranial fossae bear the weight of the while the , the outermost meningeal layer, adheres to their surfaces to form a protective barrier that separates intracranial contents from extracranial spaces and vasculature. The anterior, middle, and posterior divisions house specific brain regions, such as the frontal lobes, temporal lobes, and , respectively.

General location and divisions

The constitute the inferior aspect of the , forming the floor of the and providing structural support for the . This base extends anteriorly from the to the posterior , creating a progressively deepening platform that accommodates the 's contours. The is divided into three primary fossae—anterior, middle, and posterior—each corresponding to specific regions of the . The is the smallest division, positioned at the forefront to overlay the orbits and support the frontal lobes. The middle cranial fossa occupies the central portion, bridging the anterior and posterior regions while accommodating the temporal lobes and adjacent structures, including the . The represents the largest division, extending deepest to house the and . Relative to one another, the anterior fossa is shallow and wide, facilitating a broad, level surface; the middle fossa adopts a butterfly-shaped configuration, narrower medially and flaring laterally; and the posterior fossa is the deepest and most voluminous, forming a tent-like enclosure beneath the tentorium cerebelli. These divisions arise primarily from contributions by the , , and in the anterior fossa; the and in the middle; and the and in the posterior.

Embryology and development

Formation of the cranial base

The formation of the cranial base begins during early embryogenesis with the development of the chondrocranium, a cartilaginous framework derived primarily from paraxial and cranial cells. These cells contribute to the central and peripheral components, respectively, with neural crest cells migrating ventrally around the developing to populate the midline and form key precursors such as the presphenoid and basisphenoid cartilages. Paraxial , in contrast, gives rise to more posterior elements like the parachordal and hypochordal bars. This process occurs between weeks 4 and 7 of gestation, initiating with mesenchymal condensations that differentiate into chondroblasts, establishing multiple chondrification centers including the ethmoidal, presphenoidal, and basisphenoidal regions. Ossification of the cranial base follows a predominantly endochondral , commencing around week 8 of as hypertrophic chondrocytes in the model undergo and vascular invasion, leading to bone formation. The presphenoid and basisphenoid ossify , with initial centers appearing by the end of the embryonic period, while the undergoes chondrification around week 9, with beginning in the 5th-6th fetal months. Fusion of these elements progresses gradually, with the achieving complete fusion by adolescence, typically between ages 15 and 20. Certain peripheral parts, such as the squamous portions of the , undergo membranous directly from mesenchymal tissue without a cartilaginous intermediate. Key developmental milestones include the targeted migration of cells, which delaminate from the dorsal around week 4 and contribute specifically to the ethmoid and sphenoid components through interactions with surrounding and . This migration is crucial for establishing the rostrocaudal patterning of the cranial base. Additionally, Sonic hedgehog (Shh) signaling plays a pivotal role in regulating midline structures, promoting cell survival, proliferation, and differentiation into precursors while preventing defects in ventral midline development. Disruption of Shh pathways can impair these processes, highlighting its essential function in coordinating chondrogenesis along the cranial base axis.

Anatomical variations

Anatomical variations in the cranial fossae encompass deviations in depth, symmetry, and foraminal structures that can influence neurovascular pathways without necessarily causing . Asymmetry in fossa depth is a common finding, with studies reporting cranial rates ranging from 2.8% to 6.5% across age groups in healthy populations, often manifesting as shallower depths in the posterior fossa due to underdevelopment during . In the , olfactory fossa occurs in approximately 7.4% of individuals, with deeper fossae more frequently observed on the right side in about 52% of asymmetric cases. Accessory foramina in the , particularly in the middle cranial fossa, represent another prevalent variation; for instance, the foramen meningo-orbitale is present in up to 24.7% of cases, potentially transmitting meningeal branches or . Congenital anomalies of the cranial base include platybasia, characterized by flattening of the skull base angle beyond 143 degrees, and , where the odontoid process protrudes above the line by more than 5 mm. These conditions arise from aberrant chondrocranium development and are frequently associated with type I, in which a small posterior fossa volume contributes to cerebellar tonsillar herniation, affecting less than 1% of the general population but up to 20% in related syndromes. Such variations stem from irregular patterns in the embryological cranial base. Acquired changes in cranial fossa morphology often result from age-related remodeling, including progressive pneumatization of the that extends into the middle cranial fossa floor, observed in over 80% of adults and leading to thinning of adjacent bony structures by adulthood. This pneumatization typically completes by age 14 but continues to expand volumetrically with aging, potentially altering the depth and contour of the middle fossa in up to 83% of cases through hyperaeration patterns.

Anterior cranial fossa

Boundaries and structure

The is the shallowest and most anterior of the three cranial fossae, forming the forward portion of the floor of the . It is bounded anteriorly and laterally by the orbital plates of the , medially by the , and posteriorly by the lesser wings of the and the limbus sphenoidalis (a ridge along the anterior margin of the chiasmatic sulcus). The floor of the fossa is primarily composed of the (orbital parts), the of the in the midline, and the anterior portions of the body and lesser wings of the . Key structural features include the frontal crest, a midline ridge on the serving as an attachment site for the ; the , an upward projection from the also attaching the ; and the , a perforated horizontal plate of the that supports the olfactory bulbs. The anterior clinoid processes, formed by the medial ends of the lesser wings of the sphenoid, provide attachment for the tentorium cerebelli. This fossa's thin bony composition, particularly the , makes it susceptible to fractures from frontal impacts.

Contents and foramina

The anterior cranial fossa houses the anteroinferior aspects of the frontal lobes of the cerebral hemispheres and the olfactory bulbs and tracts, which relay olfactory information to the entorhinal and piriform cortices. Vascular structures include draining from the to the . Dural folds such as the attach within the fossa, dividing the left and right cerebral hemispheres. Several foramina in the permit the passage of neurovascular structures. The following table summarizes the major foramina and their contents:
ForamenLocationContents
foramina, midline floor fibers (CN I)
Foramen cecum, anterior midlineEmissary vein to
Anterior ethmoidal foramen, medial orbital wallAnterior ethmoidal artery, nerve, and vein
Posterior ethmoidal foramen, medial orbital wallPosterior ethmoidal artery, nerve, and vein

Middle cranial fossa

Boundaries and structure

The middle cranial fossa is a butterfly-shaped in the middle of the floor of the , formed primarily by the and the petrous and squamous parts of the temporal bones. It is bounded anteriorly by the posterior edges of the lesser wings of the and the anterior clinoid processes, with the limbus sphenoidale marking the medial anterior limit. Posteriorly, it is delimited by the superior borders of the petrous temporal bones laterally and the of the sphenoid medially, while laterally it extends to the greater wings of the sphenoid and the squamous parts of the temporal bones. The floor of the fossa is concave and supports the temporal lobes of the . Centrally, it features the of the , a saddle-like depression that houses the , bounded anteriorly by the tuberculum sellae and posteriorly by the . The hypophyseal fossa within the sella contains the , covered by the . Laterally, the greater wings of the sphenoid and the petrous temporal bones form deeper troughs that accommodate the temporal lobe poles. The superior boundary is formed by the tentorium cerebelli, a dural fold separating it from the . This structure provides passage for numerous neurovascular elements through its foramina and protects the underlying brain tissue while allowing for the cavernous sinuses on either side of the sella.

Contents and foramina

The middle cranial fossa primarily contains the temporal lobes of the cerebral hemispheres, which rest on its floor, as well as the in the . It also encompasses the cavernous sinuses laterally, which surround segments of the internal carotid arteries and house III, IV, V1, V2, and VI. The temporal lobes' medial aspects and the may approach the free edge of the tentorium cerebelli superiorly. Vascular structures include the internal carotid arteries entering via the carotid canals and the middle meningeal arteries supplying the . Several foramina in the middle cranial fossa transmit critical neurovascular structures. The following table summarizes the major foramina and their contents:
ForamenLocationContents
Optic canalSphenoid bone, medial (CN II), .
Superior orbital fissureBetween lesser and greater wings of sphenoid (CN III), (CN IV), ophthalmic division of (CN V1), (CN VI), , sympathetic fibers.
Foramen rotundumGreater wing of sphenoidMaxillary division of (CN V2).
Foramen ovaleGreater wing of sphenoidMandibular division of (CN V3), accessory meningeal artery, lesser petrosal nerve (occasionally).
Foramen spinosumGreater wing of sphenoid and vein, meningeal branch of CN V3.
Carotid canalPetrous , sympathetic plexus ().
Foramen lacerumJunction of temporal, occipital, and sphenoidSmall vessels and nerves; passes over it after exiting .
Hiatus for greater petrosal nervePetrous , petrosal branch of .
Hiatus for lesser petrosal nervePetrous (branch of CN IX).

Posterior cranial fossa

Boundaries and structure

The posterior cranial fossa is the largest and deepest of the three cranial fossae, formed primarily by the , the petrous portions of the temporal bones, and the posterior aspect of the . Its anterior boundary is defined by the of the and the clivus, a sloping bony plate formed by the basilar part of the and the posterior surface of the sphenoid body, which extends inferiorly to the . The posterior boundary consists of the squamous part of the , curving inward to meet the at its inferior limit. Laterally, the fossa is delimited by the petrous and mastoid portions of the temporal bones superiorly and the mastoid and condylar parts of the occipital bones inferiorly, creating a tapered enclosure that accommodates the structures. The superior boundary is marked by the attachment of the tentorium cerebelli, a dural fold that separates the fossa from the middle cranial fossa and supports the occipital lobes. These boundaries form a concave, basin-like depression, with the clivus providing a smooth, anteriorly elevated slope that facilitates the passage of neurovascular elements. Key structural features include the jugular fossae in the temporal bones, which house the jugular bulbs, and the internal acoustic meati within the petrous temporal bones, serving as entry points for . The fossa's depth distinguishes it from the shallower anterior and middle fossae, emphasizing its role in enclosing vital posterior components.

Contents and foramina

The posterior cranial fossa primarily houses key neural structures of the , including the positioned inferiorly and the and located anteriorly as components of the . The occupies a central position within the fossa, with its roof formed by the superior medullary velum, the inferior medullary velum overlying the , and the inferior medullary velum extending from the cerebellar tonsils. Vascular elements within the posterior cranial fossa include the vertebral arteries, which enter through the and unite to form the along the anterior aspect of the . Venous drainage is facilitated by the sigmoid sinuses, which course along the posterior aspect before transitioning into the internal jugular veins, and the , which run laterally within the attached margins of the tentorium cerebelli. Several critical foramina perforate the , allowing passage of neurovascular structures between the intracranial and extracranial compartments. The following table summarizes the major foramina and their contents:
ForamenLocationContents
, centralContinuation of the (as ), paired vertebral arteries, spinal root of CN XI, anterior and posterior spinal arteries, dural veins.
Between and CN IX (glossopharyngeal), CN X (vagus), descending CN XI (accessory), (anterior part), to (posterior part).
Internal acoustic meatus, petrous partCN VII (facial), CN VIII (vestibulocochlear), , .
, anterior lateralCN (), accompanying meningeal branch of .

Clinical significance

Fractures and trauma

Fractures of the cranial fossae, often classified as basilar skull fractures, result from high-velocity blunt force trauma and can be linear (non-displaced) or depressed (with fragment ). Linear fractures are more common and typically heal without , while depressed fractures may require surgical to prevent dural and associated complications. These injuries frequently involve the floor of the anterior, middle, or posterior cranial fossae, with anterior fractures often incorporating involvement due to the thin ethmoid and frontal . In the , fractures commonly arise from frontal blows in accidents or falls, impacting the and . Diagnosis relies on (CT) imaging with thin slices (≤1 mm) in coronal and sagittal planes, supplemented by clinical indicators such as periorbital ecchymosis () and () rhinorrhea, confirmed via beta-2-transferrin testing. Immediate complications include olfactory nerve (CN I) palsy leading to anosmia and leaks, which occur in 12-39% of cases and carry a risk of if persistent beyond 7 days. Middle cranial fossa fractures, particularly of the petrous , are frequently caused by lateral impacts during assaults or vehicle collisions, with longitudinal types being more prevalent than transverse. imaging is the gold standard for detection, often revealing or CSF otorrhea, while postauricular ecchymosis () serves as a key clinical marker. Complications encompass epidural hematomas from rupture, (CN VII) palsy in approximately 48% of otic capsule-involving cases, and or vertigo due to CN VIII involvement. Posterior cranial fossa fractures, including clival and occipital condyle types, typically stem from occipital impacts in falls or rear-end collisions, though they are rarer due to the thicker bone. Diagnostic confirmation involves scans to assess for compression, with and CSF otorrhea as indicators; vertebral artery injury may necessitate angiography. These fractures carry high mortality (40-70%) and complications such as lower cranial nerve palsies (e.g., CN VIII, IX-XII) and cervical spine instability, potentially leading to hemiplegia or insults.

Tumors and pathologies

Tumors arising in the cranial fossae are uncommon, accounting for a small fraction of all intracranial neoplasms, but their location near vital neurovascular structures often leads to significant morbidity through , compression, or invasion. These lesions can originate primarily within the skull base or extend from adjacent extracranial sites, and they encompass both benign and malignant entities, including meningiomas, schwannomas, chordomas, and metastatic deposits. Diagnosis typically relies on contrast-enhanced MRI, which delineates tumor extent and involvement of surrounding tissues, while provides bony detail for assessing or . Management involves multidisciplinary approaches, including surgical resection, radiotherapy, and targeted therapies, tailored to tumor and location. In the , tumors often involve the olfactory groove, planum sphenoidale, or , frequently presenting with , visual disturbances, or due to dural . Meningiomas are among the most common, arising from the dura and exhibiting in up to 90% of cases, appearing hyperdense on and isointense on MRI with avid enhancement. Olfactory neuroblastomas (esthesioneuroblastomas), originating from the , represent approximately 3-6% of sinonasal tumors and show heterogeneous enhancement with possible intracranial extension via the . Sinonasal carcinomas and esthesioneuroblastomas may invade superiorly, causing bony remodeling visible on imaging. Fibrous dysplasia, a tumor-like , presents with ground-glass matrix on in 56% of cases and can mimic neoplastic processes. The middle cranial fossa harbors tumors affecting the sphenoid wing, petrous apex, or sellar region, often manifesting as cranial nerve deficits, endocrine dysfunction, or syndrome. Pituitary adenomas, the most frequent sellar masses, are typically benign and isointense on T1-weighted MRI, with potential skull base invasion in macroadenomas leading to bony erosion. Chondrosarcomas, arising from cartilaginous remnants at the petrooccipital , appear osteolytic on and hyperintense on T2-weighted MRI with peripheral enhancement in 73% of cases, showing a predilection for off-midline growth. Chordomas, midline clival lesions, are hyperintense on T2 sequences and demonstrate honeycomb-like enhancement, metastasizing in up to 30% of instances. Schwannomas of the (1-8% of all schwannomas) form tubular masses with cystic components, while Rathke's cleft cysts and craniopharyngiomas represent benign cystic pathologies that may compress adjacent structures. Posterior cranial fossa tumors, comprising 50-65% of pediatric brain neoplasms but fewer in adults, frequently cause , , or cranial neuropathies due to cerebellar or involvement. In children, medulloblastomas, pilocytic astrocytomas, ependymomas, and gliomas predominate, with medulloblastomas arising from the vermis and showing restricted on MRI. Acoustic neuromas (vestibular schwannomas), the most common cerebellopontine angle tumor in adults (>80% of such lesions), are benign and slow-growing, presenting with and appearing as tubular, T2-hyperintense masses with variable enhancement. Meningiomas, the second most frequent in this region, can be aggressive and arise from the petrous apex or tentorium. Chordomas and chondrosarcomas also occur here, with chordomas off-midline in 33% of cases, while hemangioblastomas manifest as cystic lesions with mural nodules in younger adults. Non-neoplastic pathologies include arachnoid cysts and epidermoids, which may mimic tumors on imaging.

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