Panagiotis zogopoulos, anastasios venetikidis, georgios vretakos and dimitrios rologis. 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. Pdf foramen magnum meningioma foramen magnum meningioma fmm represents 2% all of meningiomas. 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. If the inline pdf is not rendering correctly, you can download the pdf file here.
Meningeal tumor obstructing the foramen magnum is relatively rare and until recently has seldom been diagnosed ante mortem. A meningioma is a tumor that grows from the dura membrane blue covering the brain and spinal cord. 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. Since 1937 about 35 cases have been reported in which various kinds of tumors obstructing the foramen magnum were successfully removed. Foramen magnum meningiomas neurosurgery oxford academic. These are among the most challenging of all meningiomas to treat. Contemporary approaches to diagnostics and treatment of. Located in the fluid chambers that produce and carry cerebrospinal fluid throughout the brain. Intradurally, foramen magnum meningiomas are classified posterior, lateral, and anterior if their insertion is, respectively, posterior to the dentate. 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.
Although meningiomas account for almost 20% of brain tumors, only 1. Foramen magnum meningiomas fmms are slow growing, most often intradural and extramedullary tumors that pose significant challenges to the skull base. We present the case of a 38yearold female with neck pain, dysphonia, and slight twelfth nerve palsy. In this clinical report of 14 patients, we describe a novel imaging finding within the foramen magnum that simulates disease. Surgery is the first line of treatment, followed by radiation. Anatomical basis of approaches to foramen magnum and. This quite vascular meningioma of the foramen magnum came to light as a result of swallowing difficulties. Two cases of atypical foramen magnum meningioma presenting as. 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. Pdf surgical management of foramen magnum meningiomas. As these tumors are indolent, there occurs a long interval between onset of symptoms and diagnosis 35.
Foramen magnum and high cervical cord lesions simulating degenerative disease of the nervous system. It is oval in shape with a large anteroposterior diameter 2. Foramen magnum meningiomas fmm represent a challenge for neurosurgeons. However, they are the most common benign intracranial, extraaxial tumors arising at the craniocervical junction. Foramen magnum meningioma the neurosurgical atlas, by. Preoperative and postoperative contrastenhanced t1weighted images demonstrate the ventrally located foramen magnum meningioma between two intradural vertebral arteries. Some anatomical and surgical remarks through five cases. Foramen magnum meningiomas fmms are challenging tumors. These tumors can compress the cranial nerves, causing facial symptoms or loss of hearing. Because of their anatomic peculiarities, indolent and innocu ous. Gross anatomy the foramen magnum is found in the most inferior part of the posterior crani. Pieces of coagulated dura mater, brain stem and merge of vertebral arteries arrow with branching left anterior spinal artery can be found.
Tailored far lateral approach to anterior foramen magnum. Foramen magnum meningiomas are rare tumors, accounting for only 0. 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. A diagnosis of mirror meningioma at foramen magnum was made and resection was planned. We report a classification system based on our experience of 107 tumors.
C1c2 into foramen magnum meningioma spinal cord tumor support. The foramen magnum is an ovalshaped opening in the occipital bone bound by the basiocciput anteriorly, the occipital condyles laterally, and the supraocciput posteriorly. The lesion is hyperintense on 3dflair and enhances on 3d gradientecho sequences but is not seen on 2dtse. Meningioma obstructing the foramen magnum archives of. 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. 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 first case of a fm meningioma was an autopsy finding by hallopeau 21 in 1872 in the lariboisiere hospital in paris. 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. Versatility of suboccipital approach for foramen magnum. Experience of a single institution treating foramen magnum. 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. Case archives foramen magnum meningioma embolization. Tortuous nature of left vertebral artery with odontoid arcade source of meningioma supply. Meningiomas are slowgrowing benign tumors that arise at any location where arachnoid cells reside. Introduction meningioma is the commonest tumor in the region of foramen magnum. Experience of a single institution treating foramen magnum meningiomas. The craniospinal type arose above the foramen magnum fm and project downward into the spinal canal pushing the medulla chiefly backward. We report a case of fmm in male patient who presented with ataxia. Classification system of foramen magnum meningiomas.
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. Meningiomas account for nearly onefifth of all primary intracranial neoplasms, and nearly 3% of meningiomas arise at the foramen magnum. Foramen magnum meningiomas fmms represent a common histological tumor in a rare and eloquent location. Pdf foramen magnum meningiomas represent a common histological tumor in a rare and eloquent location. These neoplasms represent, by various estimates, around 0. Intraoperative monitoring of foramen occipitalis magnum. It is one of the several oval or circular openings foramina in the base of the skull. For midline posterior tumors that do not cross the plane of the dentate. Department of neurosurgery, metropolitan hospital, athens, greece. Resection of a large foramen magnum meningioma meningiomas comprise up to 20% of all intracranial tumors.
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. Atypical meningioma in foramen magnum is very rare. Located near the opening at the base of the skull through which the lower portion of the brainstem passes. The spinal cord, an extension of the medulla oblongata, passes through the foramen magnum as it exits the cranial cavity. 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. Magnetic resonance imaging mri of the brain showed foramen magnum meningioma encasing le vertebral artery. The transcondylar approach to craniocervical meningiomas. The craniospinal type arose above the foramen magnum fm and project downward into the spinal canal pushing the medulla chiefly. The tumor was highly vascular with different dural attachments posterior to dentate ligaments, on either side. Foramen magnum meningiomas fmm are described as meningiomas whose insertion zones are mainly. The three main algorithm criteria included the compartment of development of the tumor, its dural insertion, and its relation.
A 58yearold woman presented with an 18month history of progressive dysphagia, chronic cough and 30pound. Far lateral approach for resection of a foramen magnum. Right farlateral approach for resection of foramen magnum. Intradural extramedullary foramen magnum enhancing lesions may be due to meningioma, nerve sheath tumor, aneurysm, or meningeal disease. The first successful surgical resection of foramen magnum meningiomas fmms was reported by elsberg in 1927 and comprised a suboccipital craniotomy and c1c3 laminectomy. Meningiomas comprise 70% of benign tumors that arise at the foramen magnum 22, 30. Petroclival tumors can compress the trigeminal nerve, resulting in facial pain or spasms of the facial muscles. We present a case of a foramen magnum meningioma that highlights the importance of the neurologic exam when evaluating a patient with dysphagia. The farlateral approach for foramen magnum meningiomas. Foramen magnum meningiomas were classified as anterior 80 cases, anterolateral 24 cases, and posterolateral 10 cases.
Ventral foramen magnum meningiomas vfmms are rare lesions that account for more than 3% of all meningiomas. Insidious presentation of a foramen magnum meningioma a. These tumors tend to go undiagnosed or misdiagnosed for long periods because of the variety of presenting symptoms. Large calcified intradural extramedullary meningioma in c1c2 extending up into the foramen magnum. Shanko yuri1, smeyanovich arnold1, tanin andrei1, sych ekaterina1, smeyanovich vitali1. Microsurgical management of ventral and ventrolateral foramen magnum meningiomas. Meningiomas at the foramen magnum arise from the dura of the craniocervical junction. It facilitates the access to the anterior foramen magnum and reduces the retraction of vital structures. The article presents analysis of 20 cases of foramen occipitalis magnum menin giomas surgery. Meningioma of the foramen magnum fmm are unusual and comprise only 0. Case report meningioma of foramen magnum causing drop attacks. A sphenoid ridge meningioma is found along the ridge of bone behind the eyes and nose.
C1c2 into foramen magnum meningioma spinal cord tumor. 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. 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. Surgical removal of foramen magnum meningiomas poses great challenges. After detailing the relevant anatomy of the foramen magnum area. The state after resection of foramen magnum meningioma of anterolateral localization. Surgery on anterior foramen magnum meningiomas using a. Right farlateral approach for resection of foramen magnum meningioma. 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. Multiple surgical strategies have been reported to treat these lesions in their variable location. Meningiomas comprise up to 20% of all intracranial tumors.
Case report meningioma of foramen magnum causing drop. The appreciation of such an association may be of diagnostic value. In at least two thirds of these cases the tumor was an upper cervical meningioma projecting into the foramen. 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.
Bertalanffy h, gilsbach jm, mayfrank l, klein hm, kawase t, seeger w. 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. 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. Microsurgical resection of foramen magnum meningioma thru. Foramen magnum meningiomas represent a common histological tumor in a rare and eloquent location. There were 68 female and 46 male patients mean age, 52. Although meningiomas account for a sizable proportion of all primary intracranial neoplasms 14. Mri shows an extraaxial lesion nearly completely filling the foramen magnum. Foramen magnum fm meningiomas are challenging lesions. Pheochromocytoma and meningioma of the foramen magnum. The utility of preoperative embolization depends on several factors, such as tumor size, location, and vascularity. The foramen magnum is the largest foramen of the skull and is part of the occipital bone 1. Foramen magnum meningioma the neurosurgical atlas, by aaron. Figure 441 mri is the diagnostic study of choice for foramen magnum meningiomas providing information both for differential diagnosis and surgical planning.
The authors comprehensively ana lyzed multiple features in a series ofvfmms. We describe key historical, epidemiological, genetic, epigenetic, clinical, and neurosurgical aspects of foramen magnum meningiomas. 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. Dorsal foramen magnum mass is seen compressing the cervicomedullary junction and upper cervical cord. Foramen magnum fm meningiomas account for approximately 1. Some meningiomas can cause problems despite their benign nature, because they are difficult to remove when they are located in. Despite locating in a narrow region, they have a slow growth pattern with insidious clinical symptoms. Surgical management of foramen magnum meningiomas springerlink. The far lateral approach is considered the safest neurosurgical approach for excising foramen magnum lesions. Only one case report was found so far in literature.
329 396 163 396 1040 410 1288 1451 59 887 1101 1391 1408 1308 709 1048 602 1371 729 394 852 224 849 523 227 1259 284 1032 524 11 415 841 990 619 362