Abstract
Foramen magnum meningioma poses a challenge for neurosurgeons. Prognosis has generally improved with diagnostic and surgical advances over the past two decades; however, it may ultimately depend more on the surgeon's ability to tailor the approach and interpret intraoperative risks in single cases. The series comprised 64 patients operated on for ventral and ventrolateral foramen magnum meningioma. All patients underwent preoperative magnetic resonance imaging and received surgery via the dorsolateral route, rendering the series homogeneous in neuroradiological workup and surgical treatment. Particular to this series was that the majority of patients were of advanced age (n = 29; age, >65 years), had serious functional impairment (n = 30, Karnofski score <70), and large tumors (mean diameter, 3.5 cm). Total tumor removal was achieved in 52 (81 %) patients; operative mortality was nil. Early outcome varied depending on difficulties encountered at surgery (cranial nerve position and type of involvement in particular) and type of preoperative dysfunction. Long-tract signs and cerebellar deficits improved in 74 and 77 % of cases, respectively, but only 27 % of cranial nerve deficits did so. Surgical complications most often involved the cranial nerves: cranial nerve impairment, especially of the 9th through the 12th cranial nerves, due to stretching or encasement was noted in 44 cases. At final outcome assessment, two thirds of the cranial nerve deficits cleared, and all but two patients returned to a normal productive life. One patient was reoperated on during the follow-up period. Foramen magnum meningiomas behave like clival or spinal tumors depending on their prevalent extension. A dorsolateral approach tailored to tumor position and extension and meticulous surgical technique allow for definitive control of surgical complications. Scrupulous postoperative care may prevent dysphagia, a major persistent complication of surgery. Long-term observation of indolent tumor behavior at follow-up suggests that incomplete resection may be a viable surgical treatment option.
- Content Type Journal Article
- Category Original Article
- Pages 1-10
- DOI 10.1007/s10143-012-0381-6
- Authors
- Andrea Talacchi, Section of Neurosurgery, Department of Neuroscience, University of Verona, Verona, Italy
- Antonio Biroli, Institute of Neurosurgery, University Hospital, Verona, Italy
- Christian Soda, Institute of Neurosurgery, University Hospital, Verona, Italy
- Barbara Masotto, Institute of Neurosurgery, University Hospital, Verona, Italy
- Albino Bricolo, Section of Neurosurgery, Department of Neuroscience, University of Verona, Verona, Italy
- Journal Neurosurgical Review
- Online ISSN 1437-2320
- Print ISSN 0344-5607
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