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      Foramen Magnum Meningioma: a Case Report and Review of Literature

      case-report

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          Abstract

          Introduction:

          Meningiomas are slow-growing benign tumors that arise at any location where arachnoid cells reside. Although meningiomas account for a sizable proportion of all primary intracranial neoplasms (14.3–19%), only 1.8 to 3.2% arise at the foramen magnum. Their indolent development at the craniocervical junction makes clinical diagnosis complex and often leads to a long interval between onset of symptoms and diagnosis.

          Case report:

          We report a case of a 79-year-old male patient, presented with ataxia and sense of threatening fainting during verticalization. Magnetic resonance imaging revealed the presence of meningioma in the right side of craniospinal junction.

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          Ventral foramen magnum meninigiomas.

          Fohad Husain, M Sohaibani, Kenan I. Arnautovic (1999)
          Ventral foramen magnum meningiomas (VFMMs) are rare lesions that account for more than 3% of all meningiomas. These are among the most challenging of all meningiomas to treat. The authors comprehensively analyzed multiple features in a series of VFMMs. A retrospective study was performed of 18 patients who harbored a meningioma in the ventral foramen magnum (mean follow-up period, 40 months) and underwent surgery via a transcondylar approach. Sixteen patients underwent surgery for the first time: 12 underwent gross-total (75%), two near-total (12.5%), and two subtotal (12.5%) tumor removal. The remaining two patients were treated for a recurrent tumor. After obtaining postoperative Karnofsky Performance Scale (KPS) scores at follow up, statistically significant improvement was demonstrated compared with the preoperative scores. The extent of surgery and higher preoperative KPS scores were variables that showed statistically significant favorable influence on outcome. Ninth and 10th cranial nerve deficits were the most common complications contributing to a prolonged hospital stay. There were no perioperative deaths. Four patients died during the follow-up period. The first patient died of multiple myeloma. The second patient, in whom surgery was performed to treat a recurrent tumor, died 3 years after the surgery of new tumor recurrence at the age of 80 years. The remaining two patients died 1.5 and 5 months postsurgery of pulmonary embolus and endocarditis, respectively. Ventral foramen magnum meningiomas can be radically resected in a majority of patients, with frequent but transient morbidity caused by lower cranial nerve deficits. Radical removal of a recurrent tumor provides a relatively long, stable postoperative course. In patients presenting with a low KPS score a poor prognosis is demonstrated, and early diagnosis and treatment are recommended to avoid it.
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            Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisière Hospital and review of the literature

            Michaël Bruneau, Bernard George (2007)
            Foramen magnum meningiomas are challenging tumors, requiring special considerations because of the vicinity of the medulla oblongata, the lower cranial nerves, and the vertebral artery. After detailing the relevant anatomy of the foramen magnum area, we will explain our classification system based on the compartment of development, the dural insertion, and the relation to the vertebral artery. The compartment of development is most of the time intradural and less frequently extradural or both intraextradural. Intradurally, foramen magnum meningiomas are classified posterior, lateral, and anterior if their insertion is, respectively, posterior to the dentate ligament, anterior to the dentate ligament, and anterior to the dentate ligament with extension over the midline. This classification system helps to define the best surgical approach and the lateral extent of drilling needed and anticipate the relation with the lower cranial nerves. In our department, three basic surgical approaches were used: the posterior midline, the postero-lateral, and the antero-lateral approaches. We will explain in detail our surgical technique. Finally, a review of the literature is provided to allow comparison with the treatment options advocated by other skull base surgeons.
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              Foramen magnum meningiomas: clinical outcome after microsurgical resection via a posterolateral suboccipital retrocondylar approach.

              I. Sandalcioglu, S Asgari, H Bassiouni … (2006)
              We analyzed a consecutive series of patients operated for a foramen magnum (FM) meningioma located on the ventral aspect of the medulla oblongata via a posterolateral suboccipital retrocondylar approach with regard to long-term surgical outcome. Clinical data in a consecutive series of 25 patients experiencing a meningioma attached to dura of the anterior or anterolateral FM rim were retrospectively reviewed. The most common symptoms of the 19 women and six men (mean age, 59.2 yr) was cervico-occipital pain (72%) and gait disturbance (32%). Clinical examination revealed gait ataxia in 48% of the patients. As depicted from preoperative magnetic resonance imaging (MRI), dural attachment of the meningioma at the FM rim was anterior in 36% and anterolateral in 64% of cases. Tumor removal was accomplished via a posterolateral suboccipital retrocondylar approach in all patients. A Simpson Grade 2 resection was achieved in 96% of the patients. Permanent surgical morbidity and mortality rates were 8 and 4%, respectively. No tumor recurrence was observed after a mean follow-up period of 6.1 years (range, 1-14 yr) with clinical and MRI examination, and 80% of the patients have regained full daily activity. Anterior and anterolateral FM meningiomas that displace the medulla/spinal cord can be safely and completely resected via a posterolateral suboccipital retrocondylar approach. A tumor remnant should be left on critical neurovascular structures in cases with poor arachnoid dissection planes.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Acta Inform Med
                Journal ID (iso-abbrev): Acta Inform Med
                Journal ID (publisher-id): AIM
                Title: Acta Informatica Medica
                Publisher: AVICENA, d.o.o., Sarajevo (Bosnia and Herzegovina )
                ISSN (Print): 0353-8109
                ISSN (Electronic): 1986-5988
                Publication date (Print): February 2016
                Publication date (Electronic): 02 February 2016
                Volume: 24
                Issue: 1
                Pages: 74-77
                Affiliations
                [1 ]Clinical Department of Neurology, Split University Hospital Center, Split, Croatia
                [2 ]Neurological Clinic, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
                Author notes
                Corresponding author: Nikolina Ivica Mise, MD. Clinical Department of Neurology, Split University Hospital Center, Spinciceva 1, HR-21000 Split, Croatia. Phone: +385 91 551 8991. E-mail: n_ivica@ 123456net.hr
                Article
                Publisher ID: AIM-24-74
                DOI: 10.5455/aim.2016.24.74-77
                PMC ID: 4789635
                PubMed ID: 27041817
                SO-VID: 02abf76b-9c62-4083-ab2f-dab89c1c3d14
                Copyright © Copyright: © 2016 Pavao Jurinovic, Ana Repic Bulicic, Marino Marcic, Nikolina Ivica Mise, Marina Titlic, Enra Suljic
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 19 December 2015
                Date accepted : 21 January 2016
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Bioinformatics & Computational biology
                Keywords: meningioma,foramen magnum,craniocervical junction,case report
                Data availability:
                ScienceOpen disciplines: Bioinformatics & Computational biology
                Keywords: meningioma, foramen magnum, craniocervical junction, case report

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