Since 1937 about 35 cases have been reported in which various kinds of tumors obstructing the foramen magnum were successfully removed. Sep 25, 2008 the objective of the study is to describe our experience in the surgical management of foramen magnum meningiomas with regard to the clinicalradiological findings, the surgical approach and the outcomes after midterm follow up. The borders of this zone, as defined by george and george and colleagues14,17 range anteriorly. The objective of the study is to describe our experience in the surgical management of foramen magnum meningiomas with regard to the clinicalradiological findings, the surgical approach and the. The patient underwent c1 posterior arch excision, c2 laminectomy, foramen magnum decompression, and resection of lesions. Pdf surgical management of foramen magnum meningiomas. Foramen magnum fm meningiomas are challenging lesions. Magnetic resonance imaging mri of the brain showed foramen magnum meningioma encasing le vertebral artery. The first case of a fm meningioma was an autopsy finding by hallopeau 21 in 1872 in the lariboisiere hospital in paris. Foramen magnum and high cervical cord lesions simulating degenerative disease of the nervous system.
Some anatomical and surgical remarks through five cases. Contemporary technical innovations allow the utilization of common suboccipital craniotomy to treat ventrally, ventrolaterally and dorsally located fmms. Meningiomas account for nearly onefifth of all primary intracranial neoplasms, and nearly 3% of meningiomas arise at the foramen magnum. Two cases of atypical foramen magnum meningioma presenting as. Preoperative and postoperative contrastenhanced t1weighted images demonstrate the ventrally located foramen magnum meningioma between two intradural vertebral arteries. Because of their anatomic peculiarities, indolent and innocu ous. Large calcified intradural extramedullary meningioma in c1c2 extending up into the foramen magnum. Microsurgical management of ventral and ventrolateral foramen magnum meningiomas. C1c2 into foramen magnum meningioma spinal cord tumor support. Although meningiomas account for almost 20% of brain tumors, only 1. Insidious presentation of a foramen magnum meningioma a case report. Located in the fluid chambers that produce and carry cerebrospinal fluid throughout the brain. A sphenoid ridge meningioma is found along the ridge of bone behind the eyes and nose. Despite locating in a narrow region, they have a slow growth pattern with insidious clinical symptoms.
In this clinical report of 14 patients, we describe a novel imaging finding within the foramen magnum that simulates disease. As they produce delayed symptoms so their development at the craniocervical junction makes clinical diagnosis complex and often leads to a long interval between onset of symptoms and. Atypical meningioma in foramen magnum is very rare. Foramen magnum meningiomas fmms are challenging tumors. Case report meningioma of foramen magnum causing drop. We report a case of fmm in male patient who presented with ataxia. Shanko yuri1, smeyanovich arnold1, tanin andrei1, sych ekaterina1, smeyanovich vitali1. The state after resection of foramen magnum meningioma of anterolateral localization. Tailored far lateral approach to anterior foramen magnum.
However, they are the most common benign intracranial, extraaxial tumors arising at the craniocervical junction. This quite vascular meningioma of the foramen magnum came to light as a result of swallowing difficulties. In the coronal view and in the axial view, we can identify that although it is a meningioma of the anterior part of the foramen magnum, it is observed that the lesion has a displacement towards the right side. These neoplasms represent, by various estimates, around 0. These are among the most challenging of all meningiomas to treat. Introduction meningioma is the commonest tumor in the region of foramen magnum. After detailing the relevant anatomy of the foramen magnum area. Bertalanffy h, gilsbach jm, mayfrank l, klein hm, kawase t, seeger w. Meningiomas are slowgrowing benign tumors that arise at any location where arachnoid cells reside. Panagiotis zogopoulos, anastasios venetikidis, georgios vretakos and dimitrios rologis.
The craniospinal type arose above the foramen magnum fm and project downward into the spinal canal pushing the medulla chiefly backward. The lesion is hyperintense on 3dflair and enhances on 3d gradientecho sequences but is not seen on 2dtse t2wi. It is oval in shape with a large anteroposterior diameter 2. Although only about 1 to 3% of meningiomas are located at the foramen magnum fm, this tumor subtype comprises about 75% of all benign, intradural, extramedullary tumors of the cervicomedullary junction. There were 68 female and 46 male patients mean age, 52. Classification system of foramen magnum meningiomas. Surgical removal of foramen magnum meningiomas poses great challenges. Anatomical basis of approaches to foramen magnum and. These tumors can compress the cranial nerves, causing facial symptoms or loss of hearing.
A diagnosis of mirror meningioma at foramen magnum was made and resection was planned. Contemporary approaches to diagnostics and treatment of. Multiple surgical strategies have been reported to treat these lesions in their variable location. With our experienced fellowshiptrained skull base surgeons, mount sinai serves as a major center in the new york city and the tristate area for foramen magnum meningioma. The authors comprehensively ana lyzed multiple features in a series ofvfmms. Resection of a large foramen magnum meningioma meningiomas comprise up to 20% of all intracranial tumors. The farlateral approach for foramen magnum meningiomas. Some meningiomas can cause problems despite their benign nature, because they are difficult to remove when they are located in. Meningeal tumor obstructing the foramen magnum is relatively rare and until recently has seldom been diagnosed ante mortem. The tumor was highly vascular with different dural attachments posterior to dentate ligaments, on either side. Located near the opening at the base of the skull through which the lower portion of the brainstem passes. Meningiomas at the foramen magnum arise from the dura of the craniocervical junction. Microsurgical resection of foramen magnum meningioma thru.
Foramen magnum fm meningiomas are those arising anteriorly from the inferior third of the clivus to the superior edge of the c2 body, laterally from the jugular tubercle to the c2 laminae, and posteriorly from the anterior border of the occipital squama to the spinal process of c2 1, 2, 3. Only one case report was found so far in literature. Ventral foramen magnum meningiomas vfmms are rare lesions that account for more than 3% of all meningiomas. Pheochromocytoma and meningioma of the foramen magnum. Experience of a single institution treating foramen magnum.
Post contrast images appear to have limited contrast note paucity of mucosal enhancement and as such a comment on enhancement characteristics of this mass is difficult. Foramen magnum meningioma the neurosurgical atlas, by aaron. C1c2 into foramen magnum meningioma spinal cord tumor. Far lateral approach for resection of a foramen magnum. It is one of the several oval or circular openings foramina in the base of the skull. Foramen magnum meningiomas are rare tumors, accounting for only 0. Foramen magnum meningiomas were classified as anterior 80 cases, anterolateral 24 cases, and posterolateral 10 cases. Gross anatomy the foramen magnum is found in the most inferior part of the posterior crani. Dorsal foramen magnum mass is seen compressing the cervicomedullary junction and upper cervical cord.
Meningiomas classifications, risk factors, diagnosis and. Foramen magnum meningiomas fmm are described as meningiomas whose insertion zones are mainly. Meningiomas comprise 70% of benign tumors that arise at the foramen magnum 22, 30. Foramen magnum meningiomas fmms are slow growing, most often intradural and extramedullary tumors that pose significant challenges to the skull base. Case archives foramen magnum meningioma embolization. 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. Sep 20, 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. As these tumors are indolent, there occurs a long interval between onset of symptoms and diagnosis 35. Insidious presentation of a foramen magnum meningioma a. Tortuous nature of left vertebral artery with odontoid arcade source of meningioma supply. The foramen magnum is the largest foramen of the skull and is part of the occipital bone 1. Meningiomas comprise up to 20% of all intracranial tumors. A survey of the literature up to 1937 reveals only 14 cases with adequate clinical records, in all of which the diagnosis was made at necropsy.
For midline posterior tumors that do not cross the plane of the dentate. The foramen magnum is an ovalshaped opening in the occipital bone bound by the basiocciput anteriorly, the occipital condyles laterally, and the supraocciput posteriorly. Intraoperative monitoring of foramen occipitalis magnum. Meningioma of the foramen magnum fmm are unusual and comprise only 0. Meningioma obstructing the foramen magnum archives of. For a dural based homogeneously enhancing lesion, meningioma is the most likely differential and the foramen magnum if one of its recognized, albeit less common, sites. A meningioma is a tumor that grows from the dura membrane blue covering the brain and spinal cord. Foramen magnum meningiomas fmms represent a common histological tumor in a rare and eloquent location. The craniospinal type arose above the foramen magnum fm and project downward into the spinal canal pushing the medulla chiefly. Surgery is the first line of treatment, followed by radiation. Foramen magnum meningiomas represent a common histological tumor in a rare and eloquent location. Case report meningioma of foramen magnum causing drop attacks. Foramen magnum fm meningiomas account for approximately 1.
Foramen magnum meningioma the neurosurgical atlas, by. The far lateral approach is considered the safest neurosurgical approach for excising foramen magnum lesions. Large and vascular tumors in relatively accessible locations such as cerebral convexity may still not be as important to embolize preoperatively as smaller and perhaps less. The objective of the study is to describe our experience in the surgical management of foramen magnum meningiomas with regard to the clinicalradiological findings, the surgical approach and the outcomes after midterm follow up.
Foramen magnum meningiomas neurosurgery oxford academic. A 58yearold woman presented with an 18month history of progressive dysphagia, chronic cough and 30pound. The three main algorithm criteria included the compartment of development of the tumor, its dural insertion, and its relation. Results of surgical treatment in 26 cases, clinical neurology and neurosurgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. As most foramen magnum meningiomas are located ventrally, surgical resection via a farlateral or extremelateral approach may be utilized see chapter on the farlateral approach. Intradurally, foramen magnum meningiomas are classified posterior, lateral, and anterior if their insertion is, respectively, posterior to the dentate. Versatility of suboccipital approach for foramen magnum meningiomas. We present the case of a 38yearold female with neck pain, dysphonia, and slight twelfth nerve palsy. We report a classification system based on our experience of 107 tumors. Although meningiomas account for a sizable proportion of all primary intracranial neoplasms 14. Dec 15, 2007 we present a case of a foramen magnum meningioma that highlights the importance of the neurologic exam when evaluating a patient with dysphagia. Over a 5year period, 15 patients presenting with meningiomas of the foramen magnum underwent surgical treatment. Mri shows an extraaxial lesion nearly completely filling the foramen magnum.
The present communication concerns the appearance of a meningioma in a patient from whom a pheochromocytoma had previously been removed, and may indicate a further link in a group of related tumors. The article presents analysis of 20 cases of foramen occipitalis magnum menin giomas surgery. Our goal is to present our experience with 24 cases of surgically resected foramen magnum meningiomas used the midline suboccipital subtonsillar approach and discussed the present risks associated with the treatment of this condition. The appreciation of such an association may be of diagnostic value. Right farlateral approach for resection of foramen magnum. We present a case of a foramen magnum meningioma that highlights the importance of the neurologic exam when evaluating a patient with dysphagia. Department of neurosurgery, metropolitan hospital, athens, greece. 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. These tumors tend to go undiagnosed or misdiagnosed for long periods because of the variety of presenting symptoms. Salesllopis neurosurgery department, university general hospital of alicante, foundation for the promotion of health and biomedical research in the valencian region fisabio, alicante, spain foramen magnum meningiomas fmms are slow growing, most often. Right farlateral approach for resection of foramen magnum meningioma.
In at least two thirds of these cases the tumor was an upper cervical meningioma projecting into the foramen. It facilitates the access to the anterior foramen magnum and reduces the retraction of vital structures. Experience of a single institution treating foramen magnum meningiomas. The first successful surgical resection of foramen magnum meningiomas fmms was reported by elsberg in 1927 and comprised a suboccipital craniotomy and c1c3 laminectomy.
Intradural extramedullary foramen magnum enhancing lesions may be due to meningioma, nerve sheath tumor, aneurysm, or meningeal disease. If the inline pdf is not rendering correctly, you can download the pdf file here. The lesion is hyperintense on 3dflair and enhances on 3d gradientecho sequences but is not seen on 2dtse. We describe key historical, epidemiological, genetic, epigenetic, clinical, and neurosurgical aspects of foramen magnum meningiomas. Versatility of suboccipital approach for foramen magnum.
The transcondylar approach to craniocervical meningiomas. The utility of preoperative embolization depends on several factors, such as tumor size, location, and vascularity. Pdf foramen magnum meningioma foramen magnum meningioma fmm represents 2% all of meningiomas. Surgery on anterior foramen magnum meningiomas using a. Figure 441 mri is the diagnostic study of choice for foramen magnum meningiomas providing information both for differential diagnosis and surgical planning. Surgical management of foramen magnum meningiomas springerlink. Petroclival tumors can compress the trigeminal nerve, resulting in facial pain or spasms of the facial muscles. Foramen magnum meningiomas fmm represent a challenge for neurosurgeons. Pdf foramen magnum meningiomas represent a common histological tumor in a rare and eloquent location. Pieces of coagulated dura mater, brain stem and merge of vertebral arteries arrow with branching left anterior spinal artery can be found. The spinal cord, an extension of the medulla oblongata, passes through the foramen magnum as it exits the cranial cavity. But in the end, there would be one very happy, athletic, hardworking man named dwight, who successfully underwent surgery for a large meningioma that was markedly pressing on.