In this clinical report of 14 patients, we describe a novel imaging finding within the foramen magnum that simulates disease. Surgery on anterior foramen magnum meningiomas using a. Several surgical approaches have been proposed for the removal of foramen magnum meningiomas fmms including the standard midline suboccipital craniotomy and high cervical laminectomy. The lesion is hyperintense on 3dflair and enhances on 3d gradientecho sequences but is not seen on 2dtse t2wi. Some meningiomas can cause problems despite their benign nature, because they are difficult to remove when they are located in. Atypical meningioma in foramen magnum is very rare. They occur in 6898% of all cases of foramen magnum meningiomas 1, 35 fig. These are benign, slowgrowing and indolent tumors which often become large prior to clinical presentation. Lateral projection of foramen magnum, illustrating contrast substance in interpeduncular fossa, stopping at the arachnoidal septum. The craniospinal type arose above the foramen magnum fm and project downward into the spinal canal pushing the medulla chiefly backward. In at least two thirds of these cases the tumor was an upper cervical meningioma projecting into the foramen. Contemporary technical innovations allow the utilization of common suboccipital craniotomy to treat ventrally, ventrolaterally and dorsally located fmms. 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 survey of the literature up to 1937 reveals only 14 cases with adequate clinical records, in all of which the diagnosis was made at. 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. Outcomes of stereotactic radiosurgery for foramen magnum. Cushing and eisenhard3 classified meningiomas at the craniovertebral junction into craniospinal meningiomas that originated from the basal groove at the lower third of the clivus, anterior to the medulla and projected caudally and spinocranial meningiomas. In this report, we discuss the classification, presenting symptoms, preoperative investigation, treatment indications, operative approaches and technique, postoperative. Case report meningioma of foramen magnum causing drop.
Tumors of the spinal cord which project into the posterior cranial fossa. Introduction meningioma is the commonest tumor in the region of foramen magnum. Ventral foramen magnum meningiomas arise anterior to the ascending coronal plane between the first dentate ligament and the cranial nerve cn ixcn xii on both sides. Since 1937 about 35 cases have been reported in which various kinds of tumors obstructing the foramen magnum were successfully removed. 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. As these tumors are indolent, there occurs a long interval between onset of symptoms and diagnosis 35. The foramen magnum fm is the site of tumor origin in 1. Meningiomas comprise 70% of benign tumors that arise at the foramen magnum 22, 30. Meningiomas at the foramen magnum arise from the dura of the craniocervical junction. Figure 441 mri is the diagnostic study of choice for foramen magnum meningiomas providing information both for differential diagnosis and surgical planning. Meningioma is the commonest tumor in the region of foramen magnum.
Omaha meningeal tumor obstructing the foramen magnum is relatively rare and until recently has seldom been diagnosed ante mortem. C1c2 into foramen magnum meningioma spinal cord tumor. Lazy farlateral approach to the anterior foramen magnum and lower clivus. Meningiomas are a common primary intracranial neoplasm but location at the foramen magnum is uncommon accounting for 2. It was removed through a modified modified approach foramen magnum craniectomy and resection of the posterior arch of c1 and ultrasonic aspiration. Pdf foramen magnum meningiomas represent a common histological tumor in a rare and eloquent location. The patient gave his informed consent for the publication of the case, and approval was obtained from the research department of the hospital where the procedure was. Meningiomas are slowgrowing benign tumors that arise at any location where arachnoid cells reside. Large calcified intradural extramedullary meningioma in c1c2 extending up into the foramen magnum. Foramen magnum meningiomas fmms represent a common histological tumor in a rare and eloquent location. A sphenoid ridge meningioma is found along the ridge of bone behind the eyes and nose. Meningiomas comprise up to 20% of all intracranial tumors. We present a case of a foramen magnum meningioma that highlights the importance of the neurologic exam when evaluating a patient with dysphagia. Magnetic resonance imaging mri of the brain showed foramen magnum meningioma encasing left vertebral artery.
Although meningiomas account for a sizable proportion of all primary intracranial neoplasms 14. Pdf foramen magnum meningioma foramen magnum meningioma fmm represents 2% all of meningiomas. The relationship between pheochromocytoma and other tumors of neural origin, particularly neurofibromas, has been emphasized in recent years. Multiple surgical strategies have been reported to treat these lesions in their variable location. These episodes lasted for brief period followed by full neurological recovery. The craniospinal type arose above the foramen magnum fm and project downward into the spinal canal pushing the medulla chiefly. Foramen magnum meningioma the neurosurgical atlas, by aaron. A 58yearold woman presented with an 18month history of progressive dysphagia, chronic cough and 30pound weight loss. Meningiomas are common neoplasms affecting the nervous system, and represent 20% of all primary intracranial tumors.
F oramen magnum meningiomas fmms represent only 2%3% of all meningiomas but nearly 75% of all benign extramedullary lesions at the foramen magnum. 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 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. Tortuous nature of left vertebral artery with odontoid arcade source of meningioma supply. Upper cervical spine meningiomas can extend cranially and are commonly called spinocranial fmms.
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. The study involved 23 patients with foramen magnum or lower clival meningiomas 8 men, 15 women. Intradurally, foramen magnum meningiomas are classified posterior, lateral, and anterior if their insertion is, respectively, posterior to the dentate. For a dural based homogeneously enhancing lesion, meningioma is the most likely differential and the foramen magnum if one of its recognised, albeit less common, sites. The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a. This quite vascular meningioma of the foramen magnum came to light as a result of swallowing difficulties. Her mri brain showed large foramen magnum tumor extending. These are among the most challenging of all meningiomas to treat. We analyzed a consecutive series of patients operated for a foramen magnum fm meningioma located on the ventral aspect of the medulla oblongata via a posterolateral suboccipital retrocondylar approach with regard to longterm surgical outcome. Mri shows an extraaxial lesion nearly completely filling the foramen magnum. Foramen magnum meningioma of anterolateral localization left. Ossama almefty, in brain tumors third edition, 2012. Although meningiomas account for almost 20% of brain tumors, only 1. Meningiomas classifications, risk factors, diagnosis and.
The farlateral approach for foramen magnum meningiomas. However, meningiomas arising in the foramen magnum fmm are rare, since they account for approaximately 1. The first successful surgical resection of foramen magnum meningiomas fmms was reported by elsberg in 1927 and comprised a suboccipital craniotomy and c1c3 laminectomy. Spiral computed tomography with intravenous contrast enhancement up.
Although it is benign and outside of the brain i am so frightened. Their signs and symptoms can be attributed to their close relation to the brainstem, particularly at the nondistendable area of the foramen magnum the foramen at the skull base that. Shanko yuri1, smeyanovich arnold1, tanin andrei1, sych ekaterina1, smeyanovich vitali1. Meningiomas are the most common benign intracranial neoplasms accounting for to 19% of all intracranial tumors. Intradural extramedullary foramen magnum enhancing lesions may be due to meningioma, nerve sheath tumor, aneurysm, or meningeal disease. Report of a case in which a growth was removed from the ventral and lateral aspects of the medulla oblongata and upper cervical cord. The patient had dramatic improvement after excision of the tumor. Dualenergy spiral computed tomography of patient k. We present the case of a meningioma of the foramen magnum, in a patient of age 62 yr, who presented at the time of surgery a hemiparesis on the right side at 2 mo of evolution. However foramen magnum meningioma are usually typical meningioma. Experience of a single institution treating foramen magnum meningiomas. Scribd adalah situs bacaan dan penerbitan sosial terbesar di dunia. Foramen magnum meningiomas are rare tumors, accounting for only 0.
Foramen magnum meningiomas originate from the dura of the lower third of the clivus and any portion of the fm circumferentially. Versatility of suboccipital approach for foramen magnum. Foramen magnum meningiomas neurosurgery oxford academic. 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. Surgical treatment of ventral foramen magnum meningiomas. These tumors require careful surgical manipulation as they are often located in proximity to. Foramen magnum meningiomas represent a common histological tumor in a rare and eloquent location. Pheochromocytoma and meningioma of the 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. Ventral foramen magnum meningiomas vfmms are rare lesions that account for more than 3% of all meningiomas. 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 treatments. Far lateral approach for resection of a foramen magnum. Microsurgical endoscopiccontrolled resection via a lateral suboccipital retrocondylar approach with preservation of posterior arch of atlas integrity. Foramen magnum meningioma the neurosurgical atlas, by. However, these tumors are still among the most difficult cranial base lesions to treat. Foramen magnum meningiomas fmm are described as meningiomas whose insertion zones are mainly situated in the foramen magnum fm area. The article presents analysis of 20 cases of foramen occipitalis magnum menin giomas surgery. Ventral foramen magnum meningiomas can be radically resected in a majority of patients, with fre quent but transient morbidity caused by lower cranial nerve deficits. In our study, tumors of ventral location were lateralized in 31 91.
Endoscopic endonasal approach to foramen magnum meningioma. The borders of this zone, as defined by george and george and colleagues14,17 range anteriorly. Foramen magnum tumors, the least common of the posterior fossa meningiomas, are located anterior or anterolateral to the cervicomedullary junction, and are usually intimately involved with the lower cranial nerves ixxii, the cervicomedullary junction, and the vertebral artery and its. Foramen magnum and high cervical cord lesions simulating degenerative disease of the nervous system. Intraoperative monitoring of foramen occipitalis magnum. Meningioma obstructing the foramen magnum archives of. These tumors tend to go undiagnosed or misdiagnosed for long periods because of the variety of. These tumors tend to go undiagnosed or misdiagnosed for long periods because of the variety of presenting symptoms. Experience of a single institution treating foramen magnum. The management of petroclival and foramen magnum meningiomas has been revolutionized by the techniques of cranial base surgery. Located near the opening at the base of the skull through which the lower portion of the brainstem passes. We report a case of fmm in male patient who presented with ataxia and sense of threatening. Located in the fluid chambers that produce and carry cerebrospinal fluid throughout the brain.
Radical removal ofa recurrent tumor provides a relatively long, stable postoperative course. Their signs and symptoms can be attributed to their close relation to the brainstem, particularly at the nondistendable area of the foramen magnum the foramen at the skull base that connects brain and spinal cord. Meningioma in and around foramen magnum is challenging for neurosurgeons in view of near proximity of brain stem, cranial nerve rootlets, and vertebral artery va. Foramen magnum meningiomas account for 1 to 3% of all meningiomas and 7% of all posterior fossa meningiomas. Athanasiou a, magras i, sarlis p, spyridopoulos e, polyzoidis k. Figure 6 preoperative sagittal and coronal t1weighted contrast mri enhancement of posterior foramen magnum meningioma black asterisk. My neurosurgeon has chosen to watch it and repeat mris every three months to see if it is growing. For example, a parasagittal meningioma is located near the sagittal sinus, a major blood vessel at the top of the cerebral hemispheres. Case archives foramen magnum meningioma embolization. Rhoton jr7,y introduction the foramen magnum fm is an anatomical region near the medulla. The first successful removal was accomplished by elsberg and strauss in 1927 via a.
Preoperative a, c and postoperative b, d contrastenhanced t1weighted images demonstrate the ventrally located foramen magnum meningioma between two intradural vertebral arteries. The appreciation of such an association may be of diagnostic value. Aug 05, 2012 40 years female has headache,ataxia,paraesthesia in hands and legs. These neoplasms represent, by various estimates, around 0. Incidence it is estimated that approximately 1% of the. Insidious presentation of a foramen magnum meningioma a case report. Because of their anatomic peculiarities, indolent and innocu ous. Foramen magnum meningiomas represent a challenge for neurosurgeons. Despite locating in a narrow region, they have a slow growth pattern with insidious clinical symptoms. Note proximity of anterior margin of column of oil to the vertebral bodies and clivus. Microsurgical resection is the treatment of choice for the majority of these lesions as it.
The first case of a fm meningioma was an autopsy finding by hallopeau in 1872 in the lariboisiere hospital in paris. I have just found out that i have a small meningioma in the foramen magnum area by the brainstem. Meningioma in the foramen magnum area of brain brain. George 9, 10 defined foramen magnum meningiomas as those arising anteriorly from the. Foramen magnum meningiomas are rare intracranial tumors that commonly present with lower cranial nerve deficits and motorsensory disturbances of the extremities. Meningeal tumor obstructing the foramen magnum is relatively rare and until recently has seldom been diagnosed ante mortem. Department of neurosurgery, metropolitan hospital, athens, greece. From old neuroanatomical conceptions to current far lateral neurosurgical intervention daniel s. Foramen magnum meningiomas fmm represent a challenge for neurosurgeons. Recommended articles citing articles 0 conflict of interest statement.
Panagiotis zogopoulos, anastasios venetikidis, georgios vretakos and dimitrios rologis. A meningioma is a tumor that grows from the dura membrane blue covering the brain and spinal cord. Occipital neuralgia as the only presenting symptom of foramen. Insidious presentation of a foramen magnum meningioma a. Drop attack as a presenting symptom of meningioma of foramen magnum has never been reported. To identify an appropriate surgical approach for meningiomas of the foramen magnum and lower clivus and determine the factors influencing the surgical outcomes. C1c2 into foramen magnum meningioma spinal cord tumor support. The sagittal scan show compression of upper cervical spinal cord white asterisk. Only one case report was found so far in literature. Surgery is the first line of treatment, followed by radiation. A 52yearold female presented with frequent episodes of falls without loss of consciousness. We report a case of fmm in male patient who presented with ataxia. Pdf surgical management of foramen magnum meningiomas.
This interval in the region of the odontoid should not exceed 4 mm. Magnetic resonance imaging mri of the brain showed foramen magnum meningioma encasing le vertebral artery. Foramen magnum fm meningiomas account for approximately 1. For example, the state after resection of foramen magnum meningioma of anterolateral localization figure 4.
Anterolateral meningioma of the foramen magnum and high cervical spine presenting intradural and extradural growth in a child. Meningiomas account for nearly onefifth of all primary intracranial neoplasms, and nearly 3% of meningiomas arise at 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. Dorsal foramen magnum mass is seen compressing the cervicomedullary junction and upper cervical cord. Surgical results and risks predicting poor outcomes based on a modified classification. Contemporary approaches to diagnostics and treatment of. Case report meningioma of foramen magnum causing drop attacks. It often presents with occipitocervical pain, long tract signs, and lower cranial nerve deficits 2, 3.
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