160
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisière Hospital and review of the literature

      research-article
      1 , 2 , , 1
      Neurosurgical Review
      Springer-Verlag
      Foramen magnum, Meningioma, Surgical approach, Tumor, Vertebral artery

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          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.

          Related collections

          Most cited references77

          • Record: found
          • Abstract: found
          • Article: not found

          Spinal cord meningioma.

          The authors present a retrospective analysis of 97 cases of spinal meningioma. Age, sex, tumor location, and clinical presentation are similar to that reported by others. Importantly, even among paraplegic patients, one-third eventually walked. Other findings of note were poor results among those with calcified or recurrent tumors, and a high incidence of invasiveness among the rare epidural lesions. Males do not show the preference for a thoracic location that is found among females, and cervical tumors are almost all anterior to the cord. This last point suggests a different surgical approach in some cases. A large percentage of cases carried other diagnoses before tumor was recognized.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Microsurgical anatomy of the posterior inferior cerebellar artery.

            Fifty cerebellar hemispheres from 25 adult cadavers were examined. The posterior inferior cerebellar artery (PICA), by definition, arose from the vertebral artery. The vertebral artery was present in 49 and the PICA was present in 42 of the 50 hemispheres. Forty-one of the 42 PICAs arose as a single trunk and 1 arose as a duplicate trunk. The PICA was divided into five segments: the anterior medullary segment lay on the front of the medulla; the lateral medullary segment coursed beside the medulla and extended to the origin of the glossopharyngeal, vagal, and accessory nerves; the tonsillomedullary segment coursed around the caudal half of the cerebellar tonsil; the telovelotonsillar segment coursed in the cleft between the tela choroidea and the inferior medullary velum rostrally and the superior pole of the cerebellar tonsil caudally; and the cortical segment was distributed to the cerebellar surface. Thirty-seven of the 42 PICAs bifurcated into a medial and a lateral trunk. The medial trunk supplied the vermis and the adjacent part of the hemisphere, and the lateral trunk supplied the cortical surface of the tonsil and the hemisphere. The PICA gave off perforating, choroidal, and cortical arteries. The cortical arteries were divided into vermian, tonsillar, and hemispheric groups. Sixteen of the 42 PICAs passed between the rootlets of the accessory nerve, 10 passed between the rootlets of the vagus nerve, 13 passed between the vagus and the accessory nerves, 2 coursed rostral to the glossopharyngeal nerve, and 1 passed between the glossopharyngeal and the vagus nerves.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Posterior fossa meningiomas: surgical experience in 161 cases.

              We report the clinical, radiological, and surgical findings of patients with posterior fossa meningiomas surgically treated at our institution over the last 6 years. We reviewed 161 consecutive cases of posterior fossa meningiomas operated on between April 1993 and April 1999 at The George Washington University Medical Center. There were 128 female and 33 male patients (mean age 47 years, range of 10-81 years). Meningiomas were classified as petroclival (110 cases), foramen magnum (21 cases), cerebellar hemispheric, lateral tentorial (14 cases), cerebellopontine angle (9 cases), and jugular foramen (7 cases). Mean tumor equivalent diameter (TED) = (D1xD2xDE)(1/3) was 3.1 cm (range of 0.53-8.95). Head pain (50% of cases) and disturbance of gait (44%) were the most common presenting symptoms, and cranial neuropathies the most common neurological signs on admission. Mean preoperative performance status (Karnofsky scale) was 80.2 (range 40-100). Surgical approaches to these tumors included partial labyrinthectomy petrous apicectomy, fronto-temporal/fronto-temporal orbitozygomatic osteotomy, retrosigmoidal, extreme lateral, transpetrosal, and combined. In 38 cases a staged procedure was performed. Gross-total resection was achieved in 57% of patients, and subtotal/partial in 43%. Surgical mortality was 2.5% and complications were encountered in 41% of patients. Postoperative CSF leak occurred in 22 cases (13.6%). The mean follow-up was 19 months, ranging from 0.2 to 63.6, and the mean performance status of patients with a follow-up of at least 12 months was 77 (range of 40-100). Recurrence or progression of disease was found in 13.7% of cases (follow-up 2 years or more). Our experience suggests that although posterior fossa meningiomas represent a continuing challenge for contemporary neurosurgeons, such tumors may be completely or subtotally removed with low rate of mortality and acceptable morbidity, allowing most of these patients to achieve a good outcome in a long-term follow-up.
                Bookmark

                Author and article information

                Contributors
                +32-255-53039 , +32-255-53755 , mbruneau@ulb.ac.be
                Journal
                Neurosurg Rev
                Neurosurgical Review
                Springer-Verlag (Berlin/Heidelberg )
                0344-5607
                1437-2320
                20 September 2007
                January 2008
                : 31
                : 1
                : 19-33
                Affiliations
                [1 ]Department of Neurosurgery, Lariboisière Hospital, Paris, France
                [2 ]Service de Neurochirurgie, Hôpital Erasme, Route de Lennik, 808, 1070 Brussels, Belgium
                Article
                97
                10.1007/s10143-007-0097-1
                2077911
                17882459
                b0fc6e8e-b279-400f-b59b-c8f7a52c7b12
                © Springer-Verlag 2007
                History
                : 14 February 2007
                : 28 April 2007
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag 2008

                Surgery
                meningioma,foramen magnum,vertebral artery,surgical approach,tumor
                Surgery
                meningioma, foramen magnum, vertebral artery, surgical approach, tumor

                Comments

                Comment on this article