The management of petroclival and foramen magnum meningiomas has been revolutionized by the techniques of cranial base surgery. However, these tumors are still among the most difficult cranial base lesions to treat. In this report, we discuss the classification, presenting symptoms, preoperative investigation, treatment indications, operative approaches and technique, postoperative complications and care, and results of surgery of petroclival and foramen magnum meningiomas. Careful analysis of tumor- and patient-related factors has helped us to predict which features can lead to postoperative problems in patients allowing surgeons to appropriately modify their behavior. The application of cranial base techniques-combined with new knowledge about the limitations of microsurgical resection-can greatly reduce postoperative morbidity in these patients.

Botulinum toxin A improves refractory chronic low back pain with a low incidence of side effects. The beneficial clinical response is sustained with a second treatment.

Botulinum neurotoxin A may be beneficial in patients with chronic low back pain. A favorable initial response predicts subsequent responsiveness. The treatment is well tolerated, and side effects are mild and transient.