Foramen magnum meningiomas: concepts, classifications, and nuances

Boulton, Melfort; Cusimano, Michael D.

doi:10.3171/foc.2003.14.6.10

Cited by 107 publications

(178 citation statements)

References 30 publications

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“…7,13,28,37,49 Such a prolonged-and often relapse and remitting-presentation explains the 30.8-month mean length of symptoms prior to diagnosis, even in the era of advanced neuroimaging. 7,15 Suboccipital headache and upper cervical pain are the most common early complaints, with the pain frequently exacerbated by coughing, straining, or Valsalva maneuvers. 37 The classic foramen magnum syndrome is defined by development of unilateral arm sensory and motor deficits, which progress to the ipsilateral leg, then the contralateral leg, and then the contralateral upper extremity.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…37 The classic foramen magnum syndrome is defined by development of unilateral arm sensory and motor deficits, which progress to the ipsilateral leg, then the contralateral leg, and then the contralateral upper extremity. 7 Long tract findings and spastic quadriparesis present later on in the patient's clinical course. Untreated cases may progress to quadriplegia and respiratory arrest.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…The mean age of the patients with these lesions at the time of diagnosis is approximately 55 years old, 4,7,15,17,22,23,32,33,40,47,50 and they often mimic degenerative or demyelinating diseases such as cervical spondylosis, multiple sclerosis, and amyotrophic lateral sclerosis. 7,13,28,37,49 Such a prolonged-and often relapse and remitting-presentation explains the 30.8-month mean length of symptoms prior to diagnosis, even in the era of advanced neuroimaging. 7,15 Suboccipital headache and upper cervical pain are the most common early complaints, with the pain frequently exacerbated by coughing, straining, or Valsalva maneuvers.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Associated parenchymal FLAIR signal and corresponding vasogenic edema is rarely observed, even in cases with marked brainstem distortion; if present, it may represent an indirect indicator of pial involvement and poor pial-tumor plane during resection. 7,47 The ability to adequately visualize the vertebrobasilar system and vessels adjacent to the tumor represents another great advantage of MR images on preoperative planning for FMMs. In our experience, the degree of involvement or displacement of the vertebral artery (VA), basilar artery (BA), and posterior inferior cerebellar artery (PICA) can be adequately visualized with the use of high-resolution, thin-slice T2-weighted imaging.…”

Section: Imaging Featuresmentioning

confidence: 99%

“…Important V 4 branches at the level of the foramen magnum include the PICA, anterior spinal artery, and anterior and posterior meningeal arteries. 7 The vascular supply of the foramen magnum dura originates from the anterior and posterior VA meningeal branches and the meningeal branches of the ascending pharyngeal artery, with other infrequent contributions.…”

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confidence: 99%

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The far-lateral approach for foramen magnum meningiomas

Flores¹,

Boudreaux²,

Klinger³

et al. 2013

FOC

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Foramen magnum meningiomas (FMMs) are slow growing, most often intradural and extramedullary tumors that pose significant challenges to the skull base neurosurgeon. The indolent clinical course of FMMs and their insidious onset of symptoms are important factors that contribute to delayed diagnosis and relative large size at the time of presentation. Symptoms are often produced by compression of surrounding structures (such as the medulla oblongata, upper cervical spinal cord, lower cranial nerves, and vertebral artery) within a critically confined space. Since the initial pathological description of a FMM in 1872, various surgical approaches have been described with the aim of achieving radical tumor resection. The surgical treatment of FMMs has evolved considerably over the last 4 decades due to the progress in microsurgical techniques and development of a multitude of skull base approaches. Posterior and posterolateral FMMs can be safely resected via a standard midline suboccipital approach. However, controversy still exits regarding the optimal management of anterior or anterolateral lesions. Independently of technical variations and the degree of bone removal, all modern surgical approaches to the lower clivus and anterior foramen magnum derive from the posterolateral (or far-lateral) craniotomy originally described by Roberto Heros and Bernard George. This paper is a review of the surgical management of FMMs, with emphasis on the far-lateral approach and its variations. Clinical presentation, imaging findings, important neuroanatomical correlations, recurrence rates, and outcomes are discussed.

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