Introduction: To describe our surgical technique, analyze its safety and the postoperative out come in 12 consecutive Foramen Magnum Meningiomas (FMM).
Methods: From 1986 to 2011, 12 patients with FMM underwent operations in the Department of Neurosurgery at Servidores do Estado Hospital (HSE) and in a private clinic. All patients were operated using a standard sub occipital craniectomy, preserving the occipital condyle, opening of the Foramen Magno and ipsilateral removal of the posterior arch of C1.
Results: There was no operative mortality, 9 patients achieved GOS 4 0r 5. Condylar resection was not deemed necessary in any case. Gross total tumor removal (GTR) was achieved in 9 patients. After surgery, 4 patients developed lower cranial nerve (LCN) weakness. There was no significant postoperative complication in the remainders. The average follow-up is 8,2 years.
Conclusions: The vast majority of foramen magnum meningiomas can be safely removed with a retrocondylar lateral suboccipital approach without condylar resection, using meticulous microsurgical techniques.
Patient Care: Decreasing the surgical complications
Learning Objectives: By the conclusion of this session, participants should be able to diagnose the FMMs, describe the principals symptoms and the importance of choosing the best surgical strategy .
References: 1- Cushing H, Eisenhardt L. Meningiomas: Their Classification, Regional Behavior, Life History and Surgical End Results. Springfield, IL: Charles C Thomas; 171-180,1938.
2- Elsberg CA, Strauss I: Tumors of the spinal cord which project into the posterior cranial fossa: Report of a case in which a growth was removed from the ventral and lateral aspects of the medulla oblongata and upper cervical cord. Arch Neurol Psychiatry 21: 261–273, 1929.
3- Lot G, George B: The extent of drilling in lateral approaches to the craniocervical junction area from a series of 125 cases. Acta Neurochir (Wien) 141:111–118, 1999.
4- de Oliveira E, Rhoton AL Jr, Peace DA. Microsurgical anatomy of the region of the foramen magnum. Surg Neurol. 1985; 24(3): 293-352.
5- Bertalanffy H, Gilsbach JM, Mayfrank L, Klein HM, Kawase T, Seeger W. Microsurgical management of ventral and ventrolateral foramen magnum meningiomas. Acta Neurochir. 1996; 65(Suppl): 82-85.