Vermian fossa or median occipital fossa revisited: Prevalence and clinical anatomy.

Introduction: The vermian fossa (VF) is a small midline depression at the inferior end of the internal occipital crest (IOC) near the foramen magnum. This study aims to accurately define the usual arrangement ("the norm") of the inferior end of the internal occipital crest, to determine the prevalence and dimensions of the VF in Central European population, and to state a possible correlation of the VF with anatomical variations and developmental abnormalities.

Materials And Methods: We analyzed the prevalence of the VF in 1042 dry skulls. The variable anatomy was classified into either the VF (four categories) or norm. Some rare variations of this region were also encountered.

Results: The norm was defined as a flat triangular prominence at the inferior end of the IOC, without any depression. As the most frequent arrangement, the norm appeared in 710 (68.14%) skulls. We observed the fossa in 309 (29.65%), type I in 264 (25.34%), type II in 45 (4.32%) and other rarer variations in 23 (2.21%), skulls, by our new classification system.

Conclusion: Despite many different variations can be encountered in the posterior cranial fossa, the proper definition of the usual arrangement at the inferior end of the IOC is still missing. The knowledge of such anatomical variations is essential to decrease the risk of the hemorrhage from dural venous sinuses during surgical approach. Based on prevalence, the underdeveloped posterior cerebellomedullary cistern may occur along with the VF, and their common occurrence seems probable to have a relationship to Chiari malformation type I. As for the terminology, the term median occipital fossa seems to be more appropriate.