Age-Related Volumetric Changes of the Posterior Cranial Fossa and its Structures in Stroke Patients
In brief
Cerebellar volume drops roughly 15% with age in stroke patients
In 1,280 adults scanned for cerebellar stroke, average cerebellar volume fell from about 136 cm³ in younger adults to 115 cm³ in older adults, while infratentorial CSF space grew. Men consistently had larger posterior fossa, cerebellar and brainstem volumes than women. These age- and sex-specific norms can help clinicians interpret posterior fossa imaging.
- Journal
- Cerebellum (London, England) (Q1)
- Published
- 11 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Artem Rafaelian, Daniel Cantré, Daniel Dubinski, Enayatullah Baki, Tim-Mathis Beutel, Nazife Dinc, et al.
- PMID
- 42726414
- DOI
- 10.1007/s12311-026-02082-3
Why clinicians should know about it
- Picked for Anatomy (paper of the day, 13 September 2026): Age‑related volumetric changes of posterior cranial fossa
Abstract
The posterior cranial fossa (PCF) contains critical neural structures, including the cerebellum and brainstem, whose volumetric relationships play an essential role in normal neurological function. While cranial bone growth is completed in early adulthood, brain structures may undergo age-related changes, particularly prominent in patients with stroke, potentially altering craniocerebral relationships within the PCF. Data on volumetric changes of the PCF and its contents in the adult population are limited. The aim of the study was to evaluate age- and sex-related volumetric changes of the PCF and its main neural structures in adults using MRI- and CT-based volumetric analysis.This retrospective, multicenter study included 1,280 adult subjects who underwent neuroimaging for suspected or confirmed cerebellar stroke at 11 university hospitals in Germany. In most centers, segmentation and volumetric analysis were performed using Brainlab software (Brainlab AG, Munich, Germany). In selected centers, volumetric calculations were performed using the standard method according to local protocol.PCF, cerebellar, and brainstem volumes demonstrated significant age-related changes. Cerebellar volume showed a progressive decline with increasing age from 136 cm3 (IQR 123.6-147.2) to 115.2 cm3 (IQR 107.4-131.1) (p < .001), whereas posterior fossa cerebrospinal fluid volume (PCF-CSFv) increased, indicating age-related expansion of infratentorial cerebrospinal fluid spaces. Across most age groups, males exhibited larger PCF, cerebellar, and brainstem volumes than females. In the overall cohort, these differences remained statistically significant after Holm-Bonferroni correction (all p-corrected < 0.001), whereas PCF-CSFv did not differ significantly between females and males (p-corrected = 0.438).Aging is associated with a progressive reduction of infratentorial neural tissue volumes, particularly affecting the cerebellum, accompanied by a relative expansion of PCF-CSFv. Pronounced sex-related volumetric differences persist throughout adulthood, with males demonstrating larger infratentorial structures than females. These findings provide robust normative data that may aid in the interpretation of PCF pathology in clinical and research settings.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.