Posterior fossa tumours in children

Posterior fossa tumours account for a significant proportion of paediatric brain neoplasms, representing up to 60% of solid brain tumours in children. These tumours arise in the infratentorial compartment, encompassing the cerebellum and brainstem, and commonly present with complications such as hydrocephalus. Importantly, the differential diagnosis of posterior fossa tumours in children differs markedly from that in adults, making age and tumour location critical diagnostic considerations.

The article reviews the four most common posterior fossa tumours in the paediatric population: medulloblastoma, pilocytic astrocytoma, ependymoma and diffuse midline glioma (H3 K27‑altered). Medulloblastoma is the most frequent malignant tumour, typically arising in the midline cerebellar vermis of school‑aged children and demonstrating characteristic hyperdensity on CT and diffusion restriction on MRI. Pilocytic astrocytomas, by contrast, are low grade tumours with a favourable prognosis and often present as a cystic lesion with an enhancing mural nodule, without restricted diffusion.

Ependymomas commonly arise from the fourth ventricle in young children and are notable for extension through ventricular foramina, heterogeneous enhancement and frequent calcification. Diffuse midline gliomas, most often centred in the pons, exhibit infiltrative growth, minimal enhancement and poor prognosis, with surgical options severely limited.

Although imaging features may overlap, the authors emphasise that careful assessment of tumour location, enhancement patterns, diffusion characteristics and internal heterogeneity enables radiologists to narrow the differential diagnosis and guide appropriate management.

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