Brain tumors are the most common solid tumors in children, with approximately 54–70% localized in the posterior fossa [4].

The hospital medical records of patients presenting at the neurosurgical service of our hospital, over a period of 18 years (June 1988–June 2006), were reviewed. We found a total of 142 patients with PFT. The mean age at presentation was 5.2 years (range 5 months to 16 years).

Torticollis was present in 33 patients (23%), predominantly in children aged 2 to 8 years (22 out of 74) (Fig. 1). Torticollis was principally seen in gliomas (5 out of 6) and ependymomas (6 out of 19).

Fig. 1
figure 1

Number of patients with posterior fossa tumors (full column) and patients with torticollis (shadowed portion of column) in every age range

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Tumors were mainly located at the cerebellum (57%), the fourth ventricle (17%), and the brainstem (13%). The predominant histological type was astrocytoma (51%), followed by medulloblastoma (24%), ependymoma (13%) and glioma (4%).

The clinical features were vomiting (60%), ataxia (51%), headache (48%), focal neurological signs (38%), behavioural changes (irritability, decay) (29%), torticollis (23%), diplopia (12%), nystagmus (11%), seizures (4%) and coma (4%).

Vomiting, ataxia and headache are the most common clinical symptoms reported at diagnosis of paediatric PFT in the literature [6]. We have also observed the same presentation features in our patients. The median time from symptom onset to diagnosis is more than 2 months [1, 3]. The appearance of focal neurological signs, diplopia, nystagmus or seizures alert a neurological etiology. However, acquired torticollis may not be ascribed to a PFT, especially when it is the only presenting symptom [2, 5].