Abstract
Foramen magnum meningiomas (FMMs) are a rare entity; they account for 2.5% of all intracranial meningiomas and 4% of posterior fossa meningiomas [22]. The pathologic entity of FMM was first described in 1872; the first publication describing surgical removal was in 1922 [10]. That same year Cushing described a nomenclature for these lesions and published his series. The location of these lesions at the craniocervical junction in proximity to, and possibly encasing, the lower cranial nerves or vertebral arteries makes successful removal particularly challenging [14, 20]. 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 C2, laterally by the jugular tubercles and the upper aspect of the C1 laminas, and posteriorly by the anterior edge of the squamous occipital bone and C2 spinous process [8]. The large majority (90%) of these tumors are located ventrally or ventrolaterally requiring a lateral or anterior trajectory for successful surgical removal [8, 21, 23].
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Arnautovic KI, Al-Mefty O, Husain M. Ventral foramen magnum meningiomas. J Neurosurg. 2000;92(1 Suppl):71–80.
Babu RP, Sekhar LN, Wright DC. Extreme lateral transcondylar approach: technical improvements and lessons learned. J Neurosurg. 1994;81(1):49–59.https://doi.org/10.3171/jns.1994.81.1.0049.
Bassiouni H, Ntoukas V, Asgari S, Sandalcioglu EI, Stolke D, Seifert V. Foramen magnum meningiomas: clinical outcome after microsurgical resection via a posterolateral suboccipital retrocondylar approach. Neurosurgery. 2006;59(6):1177–1185.; discussion 1185-1177.https://doi.org/10.1227/01.NEU.0000245629.77968.37.
Beer-Furlan A, Vellutini EA, Balsalobre L, Stamm AC. Endoscopic endonasal approach to ventral posterior fossa meningiomas: from case selection to surgical management. Neurosurg Clin N Am. 2015;26(3):413–26.https://doi.org/10.1016/j.nec.2015.03.006.
Bertalanffy H, Gilsbach JM, Mayfrank L, Klein HM, Kawase T, Seeger W. Microsurgical management of ventral and ventrolateral foramen magnum meningiomas. Acta Neurochir Suppl. 1996;65:82–5.
Borba LA, de Oliveira JG, Giudicissi-Filho M, Colli BO. Surgical management of foramen magnum meningiomas. Neurosurg Rev. 2009;32(1):49–58.; discussion 59–60.https://doi.org/10.1007/s10143-008-0161-5.
Boulton MR, Cusimano MD. Foramen magnum meningiomas: concepts, classifications, and nuances. Neurosurg Focus. 2003;14(6):e10.
Bruneau M, George B. Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisiere Hospital and review of the literature. Neurosurg Rev. 2008;31(1):19–32.; discussion 32–13.https://doi.org/10.1007/s10143-007-0097-1.
Crockard HA, Sen CN. The transoral approach for the management of intradural lesions at the craniovertebral junction: review of 7 cases. Neurosurgery. 1991;28(1):88–97. discussion 97–88
Flores BC, Boudreaux BP, Klinger DR, Mickey BE, Barnett SL. The far-lateral approach for foramen magnum meningiomas. Neurosurg Focus. 2013;35(6):E12.https://doi.org/10.3171/2013.10.FOCUS13332.
Fraser JF, Nyquist GG, Moore N, Anand VK, Schwartz TH. Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances. Neurosurgery. 2010;67(3 Suppl Operative):ons150–ons158.; discussion ons158.https://doi.org/10.1227/01.NEU.0000383130.80179.41.
George B, Dematons C, Cophignon J. Lateral approach to the anterior portion of the foramen magnum. Application to surgical removal of 14 benign tumors: technical note. Surg Neurol. 1988;29(6):484–90.
Heros RC. Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions. J Neurosurg. 1986;64(4):559–62.https://doi.org/10.3171/jns.1986.64.4.0559.
Kano T, Kawase T, Horiguchi T, Yoshida K. Meningiomas of the ventral foramen magnum and lower clivus: factors influencing surgical morbidity, the extent of tumour resection, and tumour recurrence. Acta Neurochir. 2010;152(1):79–86.; discussion 86.https://doi.org/10.1007/s00701-009-0511-2.
Margalit NS, Lesser JB, Singer M, Sen C. Lateral approach to anterolateral tumors at the foramen magnum: factors determining surgical procedure. Neurosurgery. 2005;56(2 Suppl):324–36. discussion 324–336
Park HH, Lee KS, Hong CK. Vertebral artery transposition via an extreme-lateral approach for anterior foramen magnum meningioma or Craniocervical junction tumors. World Neurosurg. 2016;88:154–65.https://doi.org/10.1016/j.wneu.2015.12.073.
Salas E, Sekhar LN, Ziyal IM, Caputy AJ, Wright DC. Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients. J Neurosurg. 1999;90(2 Suppl):206–19.
Samii M, Klekamp J, Carvalho G. Surgical results for meningiomas of the craniocervical junction. Neurosurgery. 1996;39(6):1086–94. discussion 1094–1085
Sekhar LN, Jannetta PJ, Burkhart LE, Janosky JE. Meningiomas involving the clivus: a six-year experience with 41 patients. Neurosurgery. 1990;27(5):764–81. discussion 781
Sekhar LN, Javed T. Meningiomas with vertebrobasilar artery encasement: review of 17 cases. Skull Base Surg. 1993;3(2):91–106.
Sen CN, Sekhar LN. An extreme lateral approach to intradural lesions of the cervical spine and foramen magnum. Neurosurgery. 1990;27(2):197–204.
Talacchi A, Biroli A, Soda C, Masotto B, Bricolo A. Surgical management of ventral and ventrolateral foramen magnum meningiomas: report on a 64-case series and review of the literature. Neurosurg Rev. 2012;35(3):359–367.; discussion 367–358.https://doi.org/10.1007/s10143-012-0381-6.
Wu Z, Hao S, Zhang J, Zhang L, Jia G, Tang J, et al. Foramen magnum meningiomas: experiences in 114 patients at a single institute over 15 years. Surg Neurol. 2009;72(4):376–382.; discussion 382.https://doi.org/10.1016/j.surneu.2009.05.006.
Yaşargil MG, Mortara RW, Curcic M. Meningiomas of basal posterior cranial fossa. In: Krayenbühl H, Brihaye J, Loew F, Logue V, Mingrino S, Pertuiset B, Symon L, Troupp H, Yasargil MG, editors. Advances and technical standards in neurosurgery. Vienna: Springer Vienna; 1980. p. 3–115.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Richardson, A.M., Au, K., Morcos, J. (2018). Foramen Magnum Meningiomas. In: Couldwell, W. (eds) Skull Base Surgery of the Posterior Fossa . Springer, Cham. https://doi.org/10.1007/978-3-319-67038-6_10
Download citation
DOI: https://doi.org/10.1007/978-3-319-67038-6_10
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-67037-9
Online ISBN: 978-3-319-67038-6
eBook Packages: MedicineMedicine (R0)