Meningiomas originating within the posterior fossa frequently cause much difficulty in diagnosis, and there are few intracranial tumors so challenging to the neurosurgeon. Whereas meningiomas in their favored locations, such as the olfactory groove, the sphenoid wing, the convexity, and the parasagittal region, give rise to characteristic clinical features, those within the posterior fossa differ widely in their mode of onset and the symptoms they produce. In some cases the development of symptoms may be so insidious and misleading that posterior fossa tumors seem remote from consideration. In other instances the histories and neurological findings are indistinguishable from those of an acoustic neurinoma. Since meningiomas in general offer a favorable prognosis, early diagnosis of the ones within the posterior fossa is particularly important because of their propensity to involve vital structures in or about the brain stem.
The incidence of subtentorial meningiomas has been very low. As recently as 1953,
MARKHAM JW, FAGER CA, HORRAX G, POPPEN JL. Meningiomas of Posterior FossaTheir Diagnosis, Clinical Features, and Surgical Treatment. AMA Arch NeurPsych. 1955;74(2):163–170. doi:10.1001/archneurpsyc.1955.02330140047008