J Korean Neurosurg Soc.  2013 Nov;54(5):373-378. 10.3340/jkns.2013.54.5.373.

Conventional Posterior Approach without Far Lateral Approach for Ventral Foramen Magnum Meningiomas

• Sohn S
• Chung CK

• KMID: 2138351
• DOI: http://doi.org/10.3340/jkns.2013.54.5.373

Abstract

OBJECTIVE
We present our experience of conventional posterior approach without fat lateral approach for ventral foramen magnum (FM) meningioma (FM meningioma) and tried to evaluate the approach is applicable to ventral FM meningioma.
METHODS
From January 1999 to March 2011, 11 patients with a ventral FM meningioma underwent a conventional posterior approach without further extension of lateral bony window. The tumor was removed through a working space between the dura and arachnoid membrane at the cervicomedullary junction with minimal retraction of medulla, spinal cord or cerebellum. Care should be taken not to violate arachnoid membrane.
RESULTS
Preoperatively, six patients were of Nurick grade 1, three were of grade 2, and two were of grade 3. Median follow-up period was 55 months (range, 20-163 months). The extent of resection was Simpson grade I in one case and Simpson grade II in remaining 10 cases. Clinical symptoms improved in eight patients and stable in three patients. There were no recurrences during the follow-up period. Postoperative morbidities included one pseudomeningocele and one transient dysphagia with dysarthria.
CONCLUSION
Ventral FM meningiomas can be removed gross totally using a posterior approach without fat lateral approach. The arachnoid membrane can then be exploited as an anatomical barrier. However, this approach should be taken with a thorough understanding of its anatomical limitation.

Keyword

Foramen magnum; Meningioma; Surgery

MeSH Terms

Arachnoid
Cerebellum
Deglutition Disorders
Dysarthria
Follow-Up Studies
Foramen Magnum*
Humans
Membranes
Meningioma*
Recurrence
Spinal Cord

Figure

• 

  Fig. 1 Illustrative case of postoperative CT (case 5). A : Preoperative T1 weighted sagittal MR image with gadolinium enhancement. B : Preoperative T1 weighted axial MR image with enhancement. C : Postoperative CT image in foramen magnum shows the extent of suboccipital craniotomy. Arrows indicate the extent of craniotomy. D : Postoperative CT image in C1 posterior arch area. Arrows indicate the extent of C1 laminotomy. E : Three dimension reconstructed postoperative CT image. Arrows indicate the extent of craniotomy and C1 laminotomy.

• 

  Fig. 2 Illustrative case 1 (case 9). A : An operative photo shows a working space between dura and arachnoid membrane at cervicomedullary junction where internal decompression is initiated. Arrow is the working space. B : An operative photo shows no mass after gross total removal. D : dura, SC : spinal cord, CB : cerebellum, T : tumor.

• 

  Fig. 3 Schematic drawing shows a working space which is between dura and arachnoid membrane at cervicomedullary junction. Dark area is the working space. A : arachnoid membrane, C1 : C1 posterior root, D : dura, DL : dentate ligament, T : tumor, SC : spinal cord.

• 

  Fig. 4 Illustrative case of gross total removal (case 7). A : Preoperative T1 weighted sagittal MR image with gadolinium enhancement. B : Preoperative T1 weighted axial MR image with enhancement. C : Postoperative T1 weighted sagittal MR image with enhancement showing no residual mass. D : Postoperative T1 weighted axial MR image with enhancement showing no residual mass.

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