Foramen magnum meningiomas are rare intracranial tumors that commonly present with lower cranial nerve deficits and motorsensory disturbances of the extremities. Figure 441 mri is the diagnostic study of choice for foramen magnum meningiomas providing information both for differential diagnosis and surgical planning. Recommended articles citing articles 0 conflict of interest statement. Tortuous nature of left vertebral artery with odontoid arcade source of meningioma supply. The 17 cases included 6 of meningioma, 6 of jugular foramen neurinoma, 2 of. These are among the most challenging of all meningiomas to treat. The case of a 4yearold boy with 4 months history of progressive quadriplegia is presented. 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. Gkrs for skull base meningiomas in earlier reports17 18 2025 have to be.
Introduction meningioma is the commonest tumor in the region of foramen magnum. Microsurgical resection is the treatment of choice in newly diagnosed foramen magnum meningiomas. 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. Contemporary approaches to diagnostics and treatment of. The three main algorithm criteria included the compartment of development of the tumor, its dural insertion, and its relation. Endoscopic endonasal approach to foramen magnum meningioma. Tentorium 9, cerebellopontine angle 27, foramen magnum 10. 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. 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. 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. We describe key historical, epidemiological, genetic, epigenetic, clinical, and neurosurgical aspects of foramen magnum meningiomas. 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. 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.
The appreciation of such an association may be of diagnostic value. Microsurgical management of ventral and ventrolateral foramen magnum meningiomas. Located near the opening at the base of the skull through which the lower portion of the brainstem passes. Far lateral approach to intradural lesions of the foramen magnum without resection of the occipital condyle. 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. Dorsal foramen magnum mass is seen compressing the cervicomedullary junction and upper cervical cord. A 58yearold woman presented with an 18month history of progressive dysphagia, chronic cough and 30pound.
Pdf the foramen magnum is of interest for various scientific disciplines. Jeanpierre barral, alain croibier, in manual therapy for the cranial nerves, 2009. Since the traditional posterior approach to meningiomas in this location does not address. Insidious presentation of a foramen magnum meningioma a. It is one of the several oval or circular openings foramina in the base of the skull. Mri shows an extraaxial lesion nearly completely filling the foramen magnum.
Department of neurosurgery, metropolitan hospital, athens, greece. I had a schwonnoma tumor removed from the foramen magnum in nov 2004. In our case, a foramen magnum meningioma was resected via a far lateral approach without preoperative embolization, ischemia, or infarction. The lesion is hyperintense on 3dflair and enhances on 3d gradientecho sequences but is not seen on 2dtse t2wi. Recall the transcondylar approach to foramen magnum meningiomas. 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. 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. 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.
Pdf meningioma of foramen magnum causing drop attacks. 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 symptoms of a meningioma depend on its size and location. The lateral bony wall of the foramen magnum is composed of the jugular. Foramen magnum meningiomas represent a common histological tumor in a rare and eloquent location. Resection of a large foramen magnum meningioma meningiomas comprise up to 20% of all intracranial tumors. 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. Foramen magnum meningioma may rarely present with drop attacks and should be considered in the differential diagnosis of the conditions causing drop attacks. Inflammatory response and meningioma tumorigenesis and the effect of cyclooxygenase2 inhibitors. Imaging features can help to distinguish a meningioma from a schwannoma.
Long term experience of gamma knife radiosurgery for. Meningiomas at the foramen magnum arise from the dura of the craniocervical junction. Meningiomas classifications, risk factors, diagnosis and. Ventral foramen magnum meningiomas vfmms are rare lesions that account for more than 3% of all meningiomas. It is opposite to and compressing the cervicomedullary junction of the spinal cord and displacing it to the anterolateral aspect of the foramen magnum. 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. These are among the most challenging of all meningiomas. Classification system of foramen magnum meningiomas.
It has caused compression of the spinal cord so i had no other options. Pheochromocytoma and meningioma of the foramen magnum. Occipital neuralgia as the only presenting symptom of. Pdf contemporary approaches to diagnostics and treatment of. The craniospinal type arose above the foramen magnum fm and project downward into the spinal canal pushing the medulla chiefly backward. 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. 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. The far lateral approach is considered the safest neurosurgical approach for excising foramen magnum lesions. Large meningioma of the foramen magnum in a 4yearold child. We report a series of patients with foramen magnum meningioma treated in our institution. Foramen magnum meningioma foramen magnum meningioma fmm represents 2% all of meningiomas. Ppt foramen magnum meningioma powerpoint presentation. Case report meningioma of foramen magnum causing drop attacks amitmahore, 1 raghvendraramdasi, 2 sandipmavani, 2 vithalrangarajan, 2 manojpatil, 2 prashantsathe, 2. Foramen magnum meningioma the neurosurgical atlas, by aaron.
The neurosurgical atlas is committed to promoting neurosurgical education free of charge. 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. The spinal cord, an extension of the medulla oblongata, passes through the foramen magnum as it exits the cranial cavity. The state after resection of foramen magnum meningioma of anterolateral localization. However foramen magnum meningioma are usually typical meningioma. In this clinical report of 14 patients, we describe a novel imaging finding within the foramen magnum that simulates disease.
The present communication concerns the appearance of a meningioma in a patient from whom a. Panagiotis zogopoulos, anastasios venetikidis, georgios vretakos and dimitrios rologis. Transcondylar fossa supracondylar transjugular tubercle. Preoperative and postoperative contrastenhanced t1weighted images demonstrate the ventrally located foramen magnum meningioma. Pdf anatomy, head and neck, foramen magnum researchgate. Pdf surgical management of foramen magnum meningiomas. Over a 5year period, 15 patients presenting with meningiomas of the foramen magnum underwent surgical treatment. Meningiomas account for approximately 25% of all spinal tumors.
Located in the fluid chambers that produce and carry cerebrospinal fluid throughout the brain. 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. Pdf contemporary approaches to diagnostics and treatment. 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. 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. Case report meningioma of foramen magnum causing drop attacks. Lateral projection of foramen magnum, illustrating contrast substance in interpeduncular fossa, stopping at the arachnoidal septum. Post contrast images appear to have limited contrast note paucity of.
Nanda a, vincent da, vannemreddy ps, baskaya mk, chanda a. The patient underwent neurosurgical resection of her mass with near complete resolution of her neurologic symptoms. The utility of preoperative embolization depends on several factors, such as tumor size, location, and vascularity. These neoplasms represent, by various estimates, around 0. Surgical treatment of ventral foramen magnum meningiomas. In contrast, the flat bones that combine to shape the major portion of the. Falcine meningiomas arise from the falx cerebri and make up approximately 5% to 9% of all intracranial meningiomas. As these tumors are indolent, there occurs a long interval between onset of. Meningiomas are more likely to demonstrate a clear dural attachment. Symptoms depend on the location and occur as a result of the tumor pressing on nearby tissue. The craniospinal type arose above the foramen magnum.
From left to right, they demonstrate meningiomas at c7t1, t56, and t1011. Bertalanffy h, gilsbach jm, mayfrank l, klein hm, kawase t, seeger w. It facilitates the access to the anterior foramen magnum and reduces the retraction of vital structures. Insidious presentation of a foramen magnum meningioma a case report. 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.
The second most frequent location for meningiomas of the posterior fossa is on the anterior rim of the foramen magnum. Apr 29, 2016 surgical excision of foramen magnum meninigioma brain tumor at apollo speciality hospital, chennai. These tumors may extend for a considerable distance up the clivus or down into the spinal canal. We report a classification system based on our experience of 107 tumors. The homogeneously enhancing tumor arises predominantly in an anterior location with some left lateral contribution. Intradurally, foramen magnum meningiomas are classified posterior, lateral, and anterior if their insertion is, respectively, posterior to the dentate. The foramen magnum has an oval shape with a large anteriorposterior.
Meningioma in the foramen magnum area of brain brain. Although only about 1 to 3% of meningiomas are located at the foramen magnum fm, this tumor subtype. 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. The farlateral approach for foramen magnum meningiomas.
Anatomical basis of approaches to foramen magnum and. Describe the suboccipital approach to foramen magnum meningiomas. Pieces of coagulated dura mater, brain stem and merge of vertebral arteries arrow with branching left anterior spinal artery can be found. I was in hospital about 18 dys and had fully recovered. We use cookies to make interactions with our website easy and meaningful, to better understand the use of our services, and to tailor advertising. Pieces of coagulated dura mater, brain stem and merge of vertebral arteries arrow with branching left. Pathology confirmed diagnosis of a who grade i meningothelial meningioma. Preoperative and postoperative contrastenhanced t1weighted images demonstrate the ventrally located foramen magnum meningioma between two intradural vertebral arteries. Meningioma of the foramen magnum when unrecognised may lead to progressive myelopathy with quadriplegia, dysphagia, and sphincter disturbance. Experience of a single institution treating foramen magnum meningiomas. 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. 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. Right axial t1weighted gdenhanced mr image obtained at the level of the foramen magnum. Intraventricular chordoid meningioma presenting with castleman disease due to overproduction of interleukin6.
The pathologic entity of fmm was first described in 1872. Case archives foramen magnum meningioma embolization. Foramen magnum meningiomas fmms represent a common histological tumor in a rare and eloquent location. Iatrogenic acute ischemic necrosis due to emergent. Magnetic resonance imaging mri of the brain showed foramen magnum meningioma encasing le vertebral artery. Foramen magnum meningioma the neurosurgical atlas, by.
Foramen magnum meningiomas fmms are challenging tumors. Case report meningioma of foramen magnum causing drop. Meningiomas of the foramen magnum occupy between 1. Meningiomas are the most common benign intracranial neoplasms accounting for to 19% of all intracranial tumors. Foramen magnum meningiomas are rare tumors, accounting for only 0. As these tumors are indolent, there occurs a long interval between onset of symptoms and diagnosis 3 5. Explain the postoperative care and complications related to surgical techniques offoramen magnum meningiomas. Identify the surgical anatomy and approaches to the foramen magnum region. Intradural extramedullary foramen magnum enhancing lesions may be due to meningioma, nerve sheath tumor, aneurysm, or meningeal disease. Within 30 years a total of 60 patients with infratentorial meningiomas have been treated at the leipzig neurosurgical clinic. This quite vascular meningioma of the foramen magnum came to light as a result of swallowing difficulties. The clinical symptomatology is usually insidious and consists of headache. 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.
680 116 43 1288 998 707 655 879 1376 914 536 651 649 923 535 1059 117 551 63 168 628 984 94 1058 941 1145 408 1495 934 798 1267 1209 342 986 221