Located in the fluid chambers that produce and carry cerebrospinal fluid throughout the brain. 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. 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. The management of petroclival and foramen magnum meningiomas has been revolutionized by the techniques of cranial. A 58yearold woman presented with an 18month history of progressive dysphagia, chronic cough and 30pound. Jeanpierre barral, alain croibier, in manual therapy for the cranial nerves, 2009. Panagiotis zogopoulos, anastasios venetikidis, georgios vretakos and dimitrios rologis. Classification system of foramen magnum meningiomas ncbi. Tumors of the spinal cord which project into the posterior cranial fossa. Intradurally, foramen magnum meningiomas are classified posterior, lateral, and anterior if their insertion is, respectively, posterior to the dentate. From september 2002 to june 2008, eight patients with foramen magnum meningiomas arising from the anterior or anterolateral rim of the foramen magnum underwent operations in the department of neurosurgery at kasr alainy hospital, cairo university, egypt. Far lateral approach for resection of a foramen magnum. Pdf surgical management of 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. Some meningiomas can cause problems despite their benign nature, because they are difficult to remove when they are located in. Intradural extramedullary foramen magnum enhancing lesions may be due to meningioma, nerve sheath tumor, aneurysm, or meningeal disease. Foramen magnum meningiomas fmms are slow growing, most often intradural and extramedullary tumors that pose significant challenges to the skull base. Foramen magnum meningiomas are rare tumors, accounting for only 0. However, these tumors are still among the most difficult cranial base lesions to treat. In this paper professor george details his experience and understanding of the different types of. 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. Surgical management of foramen magnum meningiomas springerlink. Meningiomas are the most common benign intracranial tumor.
Foramen magnum meningiomas are the most common tumor we have addressed via this approach. The foramen magnum is an ovalshaped opening in the occipital bone bound by the basiocciput anteriorly, the occipital condyles laterally, and the supraocciput posteriorly. Versatility of suboccipital approach for foramen magnum meningiomas. We report a series of patients with foramen magnum meningioma treated in our institution. Although meningiomas account for a sizable proportion of all primary intracranial neoplasms 14. Extramedullary foramen magnum tumors and their surgical. These are benign, slowgrowing and indolent tumors which often become large prior to clinical presentation. Oct 10, 2017 his veins run cold when he realizes whos been haunting the homestead all along duration. Figure 441 mri is the diagnostic study of choice for foramen magnum meningiomas providing information both for differential diagnosis and surgical planning. The tumor was highly vascular with different dural attachments posterior to dentate ligaments, on either side. Foramen magnum and high cervical cord lesions simulating. The management of petroclival and foramen magnum meningiomas has been revolutionized by the techniques of cranial base surgery. Surgical management of foramen magnum meningiomas core. Benign extramedullary tumours of the foramen magnum are rare and when they do occur they are.
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. Despite locating in a narrow region, they have a slow growth pattern with insidious clinical symptoms. Dorsal foramen magnum mass is seen compressing the cervicomedullary junction and upper cervical cord. The craniospinal type arose above the foramen magnum fm and project downward into the spinal canal pushing the medulla chiefly backward. The craniospinal type arose above the foramen magnum fm and project downward into the spinal canal pushing the medulla chiefly.
Meningiomas classifications, risk factors, diagnosis and. Preoperative and postoperative contrastenhanced t1weighted images demonstrate the ventrally located foramen magnum meningioma between two intradural vertebral arteries. Department of neurosurgery, metropolitan hospital, athens, greece. Insidious presentation of a foramen magnum meningioma a case report. Meningioma obstructing the foramen magnum archives of. 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. Meningiomas comprise up to 20% of all intracranial tumors. Introduction meningioma is the commonest tumor in the region of foramen magnum. Most benign extramedullary intradural tumors at the foramen magnum are either a meningioma or a schwannoma. Foramen magnum meningiomas fmms represent a technical challenge even for experienced neurosurgeons, because they grow in close contact with osteoarticular, nervous, and vascular structures that cannot be sacri. Foramen magnum meningioma may rarely present with drop attacks and should be considered in the differential diagnosis of the conditions causing drop attacks. 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 c21,2,3. Spinal accessory nerve meningioma at the foramen magnum with. Although it is benign and outside of the brain i am so frightened.
Meningioma was the most common histological subtype. Contemporary technical innovations allow the utilization of common suboccipital craniotomy to treat ventrally, ventrolaterally and dorsally located fmms. The first case of a fm meningioma was an autopsy finding by hallopeau 21 in 1872 in the lariboisiere hospital in paris. The patient underwent c1 posterior arch excision, c2 laminectomy, foramen magnum decompression, and resection of lesions. Resection of a large foramen magnum meningioma meningiomas comprise up to 20% of all intracranial tumors. 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. Versatility of suboccipital approach for foramen magnum. F oramen magnum meningiomas fmms represent only 2%3% of all meningiomas but nearly 75% of all benign extramedullary lesions at the foramen magnum. Located on the upper surface of the brain cerebral convexity.
The farlateral approach for foramen magnum meningiomas. Foramen magnum meningiomas represent a common histological tumor in a rare and eloquent location. Foramen magnum meningioma the neurosurgical atlas, by aaron. Meningioma in the foramen magnum area of brain michel708. Pdf foramen magnum meningiomas represent a common histological tumor in a rare and eloquent location. 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. 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. The most commonly occurring meningiomas in the posterior cranial fossa are located along the posterior surface of the temporal bone in the region of the. If the inline pdf is not rendering correctly, you can download the pdf file here. Over a 5year period, 15 patients presenting with meningiomas of the foramen magnum underwent surgical treatment.
A sphenoid ridge meningioma is found along the ridge of bone behind the eyes and nose. Original article efficiency of posterior approach for. Meningeal tumor obstructing the foramen magnum is relatively rare and until recently has seldom been diagnosed ante mortem. Report of a case in which a growth was removed from the ventral and lateral aspects of the medulla oblongata and upper cervical cord. Magnetic resonance imaging mri of the brain showed foramen magnum meningioma encasing le vertebral artery. My neurosurgeon has chosen to watch it and repeat mris every three months to see if. Multiple surgical strategies have been reported to treat these lesions in their variable location. In this paper professor george details his experience and understanding of the different types of foramen magnum meningiomas. Occasionally seizures, dementia, trouble talking, vision problems, one sided weakness, or. 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. Meningiomas are slowgrowing benign tumors that arise at any location where arachnoid cells reside.
If premature suture fusion occurs andor endochondral ossification is abnormal, a small foramen magnum. Pheochromocytoma and meningioma of the foramen magnum. In a cadaveric specimen, we show the normal anatomy and the key landmarks for performing the approach. Os meningiomas do formen magno so patologias raras e representam um dos. Meningioma in the foramen magnum area of brain brain. Neurinomas originate most commonly from the c 2 root. Apr 29, 2016 surgical excision of foramen magnum meninigioma brain tumor at apollo speciality hospital, chennai. Author links open overlay panel masanao mohri 1 jun yamano 1 katsuhiko saito 2 mitsutoshi nakada 3. Symptoms depend on the location and occur as a result of the tumor pressing on nearby tissue. 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 lesion is hyperintense on 3dflair and enhances on 3d gradientecho sequences but is not seen on 2dtse. Spinal accessory nerve meningioma at the foramen magnum with medullar compression. A survey of the literature up to 1937 reveals only 14 cases with adequate clinical records, in all of which the diagnosis was made at necropsy.
Foramen magnum meningiomas neurosurgery oxford academic. Foramen magnum meningiomas fmms are challenging tumors. Outcomes of stereotactic radiosurgery for foramen magnum. The first successful removal was accomplished by elsberg and strauss in 1927 via a. The meningiomas that we have evaluated were located about the uppercervical and foramenmagnum region with generally small extensions into the posterior. In the coronal view and in the axial view, we can identify that although it is a meningioma of the anterior part of the foramen magnum, it is observed that the lesion has a displacement towards the right side. 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. We use cookies to make interactions with our website easy and meaningful, to better understand the use of our services, and to tailor advertising. Microsurgical resection is the treatment of choice for the majority of these lesions as it can lead to cure with total. Meningiomas of the cerebellopontine angle and foramen magnum. Meningioma of the foramen magnum when unrecognised may lead to progressive myelopathy with quadriplegia, dysphagia, and sphincter disturbance.
Abstract a very unusual case of a neurofibroma extending from the level of the fifth cervical vertebra, through. I have just found out that i have a small meningioma in the foramen magnum area by the brainstem. A diagnosis of mirror meningioma at foramen magnum was made and resection was planned. We present a case of a foramen magnum meningioma that highlights the importance of the neurologic exam when evaluating a patient with dysphagia. Located near the opening at the base of the skull through which the lower portion of the brainstem passes. In this clinical report of 14 patients, we describe a novel imaging finding within the foramen magnum that simulates disease. Posterior fossa meningioma foramen magnum surgical approach skull base a b s t r a c t objectives. Insidious presentation of a foramen magnum meningioma a. Foramen magnum meningiomas fmm represent a challenge for neurosurgeons. Case report meningioma of foramen magnum causing drop attacks. Foramen magnum fm meningiomas account for approximately 1. Pdf foramen magnum meningioma foramen magnum meningioma fmm represents 2% all of meningiomas. 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. Original article efficiency of posterior approach for ventral.
The present communication concerns the appearance of a meningioma in a patient from whom a pheochromocytoma had previously been removed, and may indicate a further link in a group of related tumors. Spinal accessory nerve meningioma at the foramen magnum. His veins run cold when he realizes whos been haunting the homestead all along duration. Foramen magnum meningioma the neurosurgical atlas, by. Foramen magnum meningiomas fmms represent a technical challenge even for experienced neurosurgeons, because they grow. The lesion is hyperintense on 3dflair and enhances on 3d gradientecho sequences but is not seen on 2dtse t2wi. Tumours in the region of foramen magnum pages with reference to book, from 119 to 122 naimurrahman department of neurosurgery, rawalpindi medical college, rawalpindi. All patients were operated using a standard suboccipital craniectomy, preserving the occipital condyle, opening of the foramen magnum, and ipsilateral removal. To demonstrate by examples the common mimics of meningioma with the differentiating features. They originate from arachnoid cap cells, which are cells within the thin, spider weblike membrane that covers the brain and spinal cord. In this report, we discuss the classification, presenting symptoms, preoperative investigation, treatment indications, operative approaches and technique, postoperative. The appreciation of such an association may be of diagnostic value. Classification, foramen magnum, meningioma, surgical approach, tumor. 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.
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