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  • Clinical outcomes after removal of low clival and foramen magnum meningiomas by means of far lateral (transcondylar) approaches.

    Final Number:

    Vitaly V. Stepanenko MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Low clival and ventral foramen magnum meningiomas constitute approximately 3-5 % of all meningiomas. Clinical symptoms and surgical techniques for removal of meningiomas of these two localizations are similar therefore they are typically studied together.

    Methods: Outcomes of 16 cases were analyzed after removal of low clival and FM meningiomas my means of FLA with partial transcondylar resection.

    Results: There were 9 (56,3%) ?ases with low clival meningiomas and 7 (43,7%) cases with ventral FM meningiomas. In 11 (68,7%) cases we used transcondylar approach with vertebral artery transposition, in 5 (31,2 %) cases condylar resection wasn’t made. Average follow-up period was 38 months. Degree of tumor resection in 14 (87,5%) cases was Simpson II and in 2 (12,5%) cases it was Simpson III. In 11(68,7%) cases the outcomes were estimated as GOS 5, in 4 ( 25 %) cases as GOS 4. 1 (6,25%) patient died 4 weeks after the surgery (stem ischemic stroke). Tumor recurrence was observed in 2(12,5%) cases. Hydrocephalus appeared 10 weeks after surgery in 1 (6,25%) case, we applied VP shunt. Low cranial nerves dysfunction was identified in 4 (25%) cases. In 3 cases LCN dysfunction was fully recovered in 6 months, in 1 case moderate dysfunction remained.

    Conclusions: FLA transcondylar approaches for low clival and ventral FM meningiomas provide reliable manipulation and visual control of anterior brain stem space. In most cases it is possible to keep craniovertebral junction stability, minimizing volume of condylus resection to 50 %. When anatomic integrity of low cranial nerves is retained the average recovery period takes 6-9 months.

    Patient Care: Our research will improve surgical outcomes for patients with foramen magnum meningiomas.

    Learning Objectives: tumors of foramen magnum


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