Anterior and middle cranial fossa in traumatic brain injury: Relevant neuroanatomy and neuropathology in the study of neuropsychological outcome

The frontal and temporal lobe regions of the brain have a high vulnerability to injury as a consequence of cerebral trauma. One reason for this selective vulnerability is how the frontal and temporal regions are situated in the anterior and cranial fossa of the skull. These concavities of the skull base cup the frontal and temporal lobes which create surface areas of contact between the dura, brain, and skull where mechanical deformation injures the brain. In particular, the sphenoid ridge and the free-edge of the tentorium cerebelli are uniquely situated to facilitate injury to the posterior base of the frontal lobe and the anterior pole and medial surface area of the temporal lobe. Three-dimensional image reconstruction with computerized tomography and magnetic resonance imaging are used to demonstrate the vulnerability of these regions. How neuropsychological deficits result from damage to these areas is reviewed and discussed.