Dorsal foramen magnum mass is seen compressing the cervicomedullary junction and upper cervical cord. Meningiomas are the most common benign intracranial neoplasms accounting for to 19% of all intracranial tumors. Microsurgical management of ventral and ventrolateral foramen magnum meningiomas. Case report meningioma of foramen magnum causing drop attacks amitmahore, 1 raghvendraramdasi, 2 sandipmavani, 2 vithalrangarajan, 2 manojpatil, 2 prashantsathe, 2. We report a series of patients with foramen magnum meningioma treated in our institution. Dec 15, 2007 we present a case of a foramen magnum meningioma that highlights the importance of the neurologic exam when evaluating a patient with dysphagia.
Mri shows an extraaxial lesion nearly completely filling the foramen magnum. Pieces of coagulated dura mater, brain stem and merge of vertebral arteries arrow with branching left anterior spinal artery can be found. Tentorium 9, cerebellopontine angle 27, foramen magnum 10. These are among the most challenging of all meningiomas. The patient underwent neurosurgical resection of her mass with near complete resolution of her neurologic symptoms. It is one of the several oval or circular openings foramina in the base of the skull.
Foramen magnum fm meningiomas are those arising anteriorly from the inferior third of the clivus to the superior edge of the c2 body, laterally from the jugular tubercle to the c2 laminae, and posteriorly from the anterior border of the occipital squama to the spinal process of c2 1, 2, 3. Pathology confirmed diagnosis of a who grade i meningothelial meningioma. Jeanpierre barral, alain croibier, in manual therapy for the cranial nerves, 2009. If you leave a meningioma untreated, it can grow as large as a grapefruit can cause persistent headaches, nausea, loss of neurological function, weakness andor numbness and tingling on one side of the body, seizures, hearing or vision loss, balance problems, and muscle weakness. I am now having surgery for a meningioma in my left frontal lobe on 72620, compared to the 1sr surgery this one should be much easier. In this clinical report of 14 patients, we describe a novel imaging finding within the foramen magnum that simulates disease. Inflammatory response and meningioma tumorigenesis and the effect of cyclooxygenase2 inhibitors. Pdf surgical management of foramen magnum meningiomas. Microsurgical resection is the treatment of choice in newly diagnosed foramen magnum meningiomas. Imaging features can help to distinguish a meningioma from a schwannoma. Foramen magnum meningiomas are rare intracranial tumors that commonly present with lower cranial nerve deficits and motorsensory disturbances of the extremities.
Resection of a large foramen magnum meningioma meningiomas comprise up to 20% of all intracranial tumors. Foramen magnum meningiomas are rare, their diagnosis and treatment are difficult, and surgical results are generally worse than for other meningiomas and complication rate is high. Located near the opening at the base of the skull through which the lower portion of the brainstem passes. Foramen magnum meningiomas fmms are undoubtfully challenging lesions due to their location, to their close relation with the neuraxis and lower cranial nerves as well as with the vertebral artery va and branches. Bertalanffy h, gilsbach jm, mayfrank l, klein hm, kawase t, seeger w. Foramen magnum meningiomas represent a common histological tumor in a rare and eloquent location. Meningioma of the foramen magnum when unrecognised may lead to progressive myelopathy with quadriplegia, dysphagia, and sphincter disturbance. The neuroradiological workup, which included computed tomography scanning and magnetic resonance imaging, showed changes consistent with the diagnosis of a large mass lesion in the area of the foramen magnum. Surgical treatment of ventral foramen magnum meningiomas. As these tumors are indolent, there occurs a long interval between onset of symptoms and diagnosis 3 5. Introduction meningioma is the commonest tumor in the region of foramen magnum. The foramen magnum has an oval shape with a large anteriorposterior. Insidious presentation of a foramen magnum meningioma a case report. The neurosurgical atlas is committed to promoting neurosurgical education free of charge.
The three main algorithm criteria included the compartment of development of the tumor, its dural insertion, and its relation. This quite vascular meningioma of the foramen magnum came to light as a result of swallowing difficulties. I had a schwonnoma tumor removed from the foramen magnum in nov 2004. Occipital neuralgia as the only presenting symptom of. Foramen magnum meningioma may rarely present with drop attacks and should be considered in the differential diagnosis of the conditions causing drop attacks. Far lateral approach to intradural lesions of the foramen magnum without resection of the occipital condyle. Sep 25, 2008 the objective of the study is to describe our experience in the surgical management of foramen magnum meningiomas with regard to the clinicalradiological findings, the surgical approach and the outcomes after midterm follow up. These are among the most challenging of all meningiomas to treat. Figure 441 mri is the diagnostic study of choice for foramen magnum meningiomas providing information both for differential diagnosis and surgical planning. Panagiotis zogopoulos, anastasios venetikidis, georgios vretakos and dimitrios rologis. The appreciation of such an association may be of diagnostic value. It facilitates the access to the anterior foramen magnum and reduces the retraction of vital structures. Right axial t1weighted gdenhanced mr image obtained at the level of the foramen magnum.
Recall the transcondylar approach to foramen magnum meningiomas. These tumors may extend for a considerable distance up the clivus or down into the spinal canal. Within 30 years a total of 60 patients with infratentorial meningiomas have been treated at the leipzig neurosurgical clinic. A well defined duralbased space occupying lesion is noted lying on the posterior aspect of the foramen magnum and the posterior neural arch of atlas with no bony invasion. Although only about 1 to 3% of meningiomas are located at the foramen magnum fm, this tumor subtype. It is opposite to and compressing the cervicomedullary junction of the spinal cord and displacing it to the anterolateral aspect of the foramen magnum. Meningiomas are more likely to demonstrate a clear dural attachment. Endoscopic endonasal approach to foramen magnum meningioma.
Tortuous nature of left vertebral artery with odontoid arcade source of meningioma supply. Iatrogenic acute ischemic necrosis due to emergent. A 58yearold woman presented with an 18month history of progressive dysphagia, chronic cough and 30pound. The second most frequent location for meningiomas of the posterior fossa is on the anterior rim of the foramen magnum. Describe the suboccipital approach to foramen magnum meningiomas. The craniospinal type arose above the foramen magnum fm and project downward into the spinal canal pushing the medulla chiefly backward. Intraventricular chordoid meningioma presenting with castleman disease due to overproduction of interleukin6. The 17 cases included 6 of meningioma, 6 of jugular foramen neurinoma, 2 of.
Case report meningioma of foramen magnum causing drop attacks. Identify the surgical anatomy and approaches to the foramen magnum region. Since the traditional posterior approach to meningiomas in this location does not address. The spinal cord, an extension of the medulla oblongata, passes through the foramen magnum as it exits the cranial cavity.
Insidious presentation of a foramen magnum meningioma a. Foramen magnum meningiomas fmms represent a common histological tumor in a rare and eloquent location. A retrospective study was performed of 18 patients who harbored a meningioma in the ventral foramen magnum mean followup period, 40 months and underwent surgery via a transcondylar approach. The homogeneously enhancing tumor arises predominantly in an anterior location with some left lateral contribution. We describe key historical, epidemiological, genetic, epigenetic, clinical, and neurosurgical aspects of foramen magnum meningiomas.
Explain the postoperative care and complications related to surgical techniques offoramen magnum meningiomas. Apr 29, 2016 surgical excision of foramen magnum meninigioma brain tumor at apollo speciality hospital, chennai. The clinical symptomatology is usually insidious and consists of headache. The farlateral approach for foramen magnum meningiomas. In contrast, the flat bones that combine to shape the major portion of the. Experience of a single institution treating foramen magnum meningiomas. Foramen magnum meningiomas fmms are challenging tumors. The symptoms of a meningioma depend on its size and location. Case report meningioma of foramen magnum causing drop. We report a classification system based on our experience of 107 tumors. Gkrs for skull base meningiomas in earlier reports17 18 2025 have to be. Meningiomas at the foramen magnum arise from the dura of the craniocervical junction. The lesion is hyperintense on 3dflair and enhances on 3d gradientecho sequences but is not seen on 2dtse t2wi.
Meningiomas of the foramen magnum occupy between 1. Classification system of foramen magnum meningiomas. Meningioma, also known as meningeal tumor, is typically a slowgrowing tumor that forms from the meninges, the membranous layers surrounding the brain and spinal cord. Transcondylar fossa supracondylar transjugular tubercle. The lateral bony wall of the foramen magnum is composed of the jugular. Meningioma research in addition to diagnosing and treating meningiomas, the experts of the johns hopkins meningioma center are leading research that is redefining the understanding of these brain tumors, their origins and directions for future treatment, including immunotherapy. Magnetic resonance imaging mri of the brain showed foramen magnum meningioma encasing le vertebral artery.
A meningioma is considered to arise from the foramen magnum if the insertion of the tumor is in the region bounded anteriorly by the lower third of the clivus and the upper edge of the body of. The far lateral approach is considered the safest neurosurgical approach for excising foramen magnum lesions. Pdf meningioma of foramen magnum causing drop attacks. Foramen magnum meningiomas are rare tumors, accounting for only 0. However foramen magnum meningioma are usually typical meningioma. Symptoms depend on the location and occur as a result of the tumor pressing on nearby tissue. The pathologic entity of fmm was first described in 1872. In our case, a foramen magnum meningioma was resected via a far lateral approach without preoperative embolization, ischemia, or infarction. The present communication concerns the appearance of a meningioma in a patient from whom a. These neoplasms represent, by various estimates, around 0. Pdf the foramen magnum is of interest for various scientific disciplines. From left to right, they demonstrate meningiomas at c7t1, t56, and t1011. Contemporary approaches to diagnostics and treatment of.
The utility of preoperative embolization depends on several factors, such as tumor size, location, and vascularity. Results of surgical treatment in 26 cases, clinical neurology and neurosurgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Large meningioma of the foramen magnum in a 4yearold child. Foramen magnum meningioma the neurosurgical atlas, by aaron. Ventral foramen magnum meningiomas vfmms are rare lesions that account for more than 3% of all meningiomas. Insidious presentation of a foramen magnum meningioma a case report panagiotis zogopoulos, anastasios venetikidis, georgios vretakos and dimitrios rologis department of neurosurgery, metropolitan hospital, athens, greece abstract foramen magnum meningiomas are rare intracranial tumors. We use cookies to make interactions with our website easy and meaningful, to better understand the use of our services, and to tailor advertising. The case of a 4yearold boy with 4 months history of progressive quadriplegia is presented. Pdf anatomy, head and neck, foramen magnum researchgate. 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. Department of neurosurgery, metropolitan hospital, athens, greece.
I was in hospital about 18 dys and had fully recovered. The craniospinal type arose above the foramen magnum. Long term experience of gamma knife radiosurgery for. Preoperative and postoperative contrastenhanced t1weighted images demonstrate the ventrally located foramen magnum meningioma. 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. Foramen magnum meningioma the neurosurgical atlas, by. Meningiomas classifications, risk factors, diagnosis and. As these tumors are indolent, there occurs a long interval between onset of. This study involved 57 patients with benign extramedullary tumors of the foramen magnum 19 neurinomas, 37 meningiomas, and one teratoma, who were operated on between 1957 and 1976. Preoperative and postoperative contrastenhanced t1weighted images demonstrate the ventrally located foramen magnum meningioma between two intradural vertebral arteries.
Falcine meningiomas arise from the falx cerebri and make up approximately 5% to 9% of all intracranial meningiomas. Case archives foramen magnum meningioma embolization. It has caused compression of the spinal cord so i had no other options. Anatomical basis of approaches to foramen magnum and. Intradurally, foramen magnum meningiomas are classified posterior, lateral, and anterior if their insertion is, respectively, posterior to the dentate. 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. Foramen magnum meningiomas fmms are undoubtfully challenging lesions due to their location, to their close relation with the neuraxis and lower cranial nerves as well as with the. Ppt foramen magnum meningioma powerpoint presentation.
Pdf contemporary approaches to diagnostics and treatment. Meningiomas account for approximately 25% of all spinal tumors. Intradural extramedullary foramen magnum enhancing lesions may be due to meningioma, nerve sheath tumor, aneurysm, or meningeal disease. Meningioma in the foramen magnum area of brain brain. 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. The state after resection of foramen magnum meningioma of anterolateral localization. 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. 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. Foramen magnum meningioma foramen magnum meningioma fmm represents 2% all of meningiomas. Pheochromocytoma and meningioma of the foramen magnum. Foramen magnum fm meningiomas account for approximately 1.
152 569 680 1513 952 1508 646 1182 1494 1079 264 429 1287 882 867 219 1437 1537 1209 1206 1369 1340 1193 314 531 1519 1209 899 209 9 333 1290 1570 46 557 362 302 643 452 270 1009 1428 147 1