Foramen magnum meningioma [Neurosurgery Wiki]

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====== Foramen magnum meningioma ======

//J.Sales-Llopis//

//Neurosurgery Department, University General Hospital of Alicante, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Alicante, Spain//

[[Foramen magnum]] [[meningioma]]s (FMMs) are slow growing, [[posterior fossa meningioma]]s  most often [[intradural]] and [[extramedullar]].
They 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 [[lamina]]e, and posteriorly from the anterior border of the occipital squama to the [[spinous process]] of C2
((öçmez C, Göya C, Hamidi C, Kamaşak K, Yilmaz T, Turan Y, et al. Three-dimensional analysis of foramen magnum and its adjacent structures. J Craniofac Surg. 2014;25(1):93–97.))
((George B, Lot G, Boissonnet H. Meningioma of the foramen magnum: a series of 40 cases. Surg Neurol. 1997;47(4):371–9.))
((Bruneau M, George B. Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisière Hospital and review of the literature. Neurosurg Rev. 2008 Jan;31(1):19-32; discussion 32-3. doi: 10.1007/s10143-007-0097-1. Epub 2007 Sep 20. PMID: 17882459; PMCID: PMC2077911.)).

===== Epidemiology =====
They represent 2% of all [[meningioma]]s
((Bruneau M, George B. Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisière Hospital and review of the literature. Neurosurg Rev. 2008 Jan;31(1):19-32; discussion 32-3. doi: 10.1007/s10143-007-0097-1. Epub 2007 Sep 20. PMID: 17882459; PMCID: PMC2077911.)).

The mean age of the patients with these lesions at the time of diagnosis is approximately 55 years old, but these tumors have been reported in patients of almost every age 
((Colli BO, Carlotti-Junior CG, Assirati-Junior JA, Borba LA, Coelho-Junior Vde P, Neder L. Foramen magnum meningiomas: surgical treatment in a single public institution in a developing country. Arq Neuropsiquiatr. 2014;72(7):528–37.))
((Pirotte BJ, Brotchi J, DeWitte O. Management of anterolateral foramen magnum meningiomas: surgical vs conservative decision making. Neurosurgery. 2010;67(3):58–70.))
((Flores BC, Boudreaux BP, Klinger DR, Mickey BE, Barnett SL. The far-lateral approach for foramen magnum meningiomas. Neurosurg Focus. 2013;35(6):E12. doi:10.3171/2013.10.FOCUS13332.))
((Borba LA, de Oliveira JG, Giudicissi-Filho M, Colli BO. Surgical management of foramen magnum meningiomas. Neurosurg Rev. 2009;32(1):49–60.))
((Goel A, Desai K, Muzumdar D. Surgery on anterior foramen magnum meningiomas using a conventional posterior suboccipital approach: a report on an experience with 17 cases. Neurosurgery. 2001;49(1):102–7.)).

===== Classification =====

[[Foramen magnum meningioma classification]].


===== Pathology =====

They have traditionally been said to involve the lower third of the [[clivus]] and the [[C1]] [[C2]] area.
However, the last categorizations are arbitrary.

There are some tumors that involve the entire clivus, and others that involve the mid and lower third
of the clivus. (The upper clivus is the area above the trigeminal root, the mid-clivus extends to the level
of the glossopharyngeal nerve, and the lower clivus is the region below the glossopharyngeal nerve).

===== Clinical Features =====
The indolent clinical course of FMMs and their insidious onset of symptoms are important factors that contribute to delayed diagnosis and relative large size at the time of presentation. Symptoms are often produced by compression of surrounding structures (such as the medulla oblongata, upper cervical spinal cord, lower cranial nerves, and vertebral artery) within a critically confined space


===== Diagnosis =====

[[Foramen magnum meningioma diagnosis]].

===== Differential Diagnosis =====

see [[Foramen Magnum Tuberculoma]]

[[IgG4-related hypertrophic pachymeningitis]]
((Suisa H, Soustiel JF, Grober Y. IgG4-related pachymeningitis masquerading as foramen magnum meningioma: illustrative case. J Neurosurg Case Lessons. 2021 Dec 6;2(23):CASE21398. doi: 10.3171/CASE21398. PMID: 36061082; PMCID: PMC9435580.)).

Primary Meningeal Melanocytoma
((Uramaru K, Sakata K, Shimohigoshi W, Kawasaki T, Manaka H. Primary Meningeal Melanocytoma Located in the Craniovertebral Junction: A Case Report and Literature Review. NMC Case Rep J. 2021 Jun 25;8(1):349-354. doi: 10.2176/nmccrj.cr.2020-0191. PMID: 35079487; PMCID: PMC8769411.))

===== Treatment =====

[[Foramen magnum meningioma treatment]].

===== Complications =====
[[Foramen magnum meningioma surgery complications]]

===== Case series =====

[[Foramen magnum meningioma case series]]

===== Case reports =====

[[Foramen magnum meningioma case reports]].

===== Videos =====

Matsoukas S, Oemke H, Lopez LS, Gilligan J, Tabani H, Bederson JB. Suboccipital Craniectomy for an Anterior Foramen Magnum Meningioma-Optimization of Resection Using Intraoperative Augmented Reality: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2022 Nov 1;23(5):e321. doi: 10.1227/ons.0000000000000373. Epub 2022 Aug 8. PMID: 36103323.
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Emerson SN, Toczylowski M, Al-Mefty O. Dejerine Syndrome Variant Due to Medullary Perforating Artery Ischemia During Foramen Magnum Meningioma Resection: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2022 Jul 1;23(1):e52-e53. doi: 10.1227/ons.0000000000000211. Epub 2022 Apr 20. PMID: 35726936.
Danish B, Costello MC, Patel NV, Higgins DMO, Komotar RJ, Ivan ME. Commentary: Dejerine Syndrome Variant Due to Medullary Perforating Artery Ischemia During Foramen Magnum Meningioma Resection: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2022 Sep 1;23(3):e205-e206. doi: 10.1227/ons.0000000000000336. Epub 2022 Jul 11. PMID: 35972118.
----
Danish B, Costello MC, Patel NV, Higgins DMO, Komotar RJ, Ivan ME. Commentary: Dejerine Syndrome Variant Due to Medullary Perforating Artery Ischemia During Foramen Magnum Meningioma Resection: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2022 Sep 1;23(3):e205-e206. doi: 10.1227/ons.0000000000000336. Epub 2022 Jul 11. PMID: 35972118.
----
Medina EJ, Revuelta Barbero JM, Porto E, Garzon-Muvdi T, Henriquez O, Solares CA, Pradilla G. Exoscopic and Microscopic Combined Far Lateral Retrocondylar Approach for Resection of a Ventral Foramen Magnum Lesion: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2022 Aug 1;23(2):e126. doi: 10.1227/ons.0000000000000250. Epub 2022 May 9. PMID: 35838470.
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Jeelani Y, Ibn Essayed W, Al-Mefty O. Extended Transcondylar Approach With C-1 Lateral Mass Resection for the Removal of a Calcified Ventral "Spinocranial" Meningioma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2022 Aug 1;23(2):e117-e118. doi: 10.1227/ons.0000000000000278. Epub 2022 May 9. PMID: 35838463.
----
Essayed W, Aboud E, Al-Mefty O. Foramen Magnum Meningioma-The Attainment of the Intra-Arachnoidal Dissection: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2021 Nov 15;21(6):E518-E519. doi: 10.1093/ons/opab317. PMID: 34498699.
----
Campero A, Baldoncini M, Villalonga JF, Paíz M, Giotta Lucifero A, Luzzi S. Transcondylar Fossa Approach for Resection of Anterolateral Foramen Magnum Meningioma: 2-Dimensional Operative Video. World Neurosurg. 2021 Oct;154:91-92. doi: 10.1016/j.wneu.2021.07.058. Epub 2021 Jul 21. PMID: 34303002.

===== Foramen magnum meningioma General University Hospital of Alicante Cases =====


A 57-year-old male patient debuted with symptoms of [[syncope]] in relation to [[choking]] in recent months. He also refers to episodes of contracture of the pharynx and tongue.

Extra-axial mass centered on the left side of the [[foramen magnum]] with a size of 2.6 x 2.1 x 3 cm (AP x T x CC) showing isointense behavior on [[T1]] and [[T2]] sequences, with [[restricted diffusion]] and homogeneous [[enhancement]] after [[contrast]] administration, with an associated [[dural tail]]. It exerts a mass effect on the proximal cervical [[spinal cord]], displacing it anterolaterally to the left and deforming it, as well as on the [[medulla oblongata]], left cerebellar [[tonsil]]s, and left [[cerebellar hemisphere]]. Said mass contacts approximately 50% of the circumference of the proximal portion of the intradural segment of the left [[vertebral artery]] (V4), without reducing its caliber. As a relevant anatomical variant, the right vertebral artery ends in [[PICA]], being the dominant left vertebral artery, from which the [[basilar artery]] is formed. It contacts the lower slope of the canal of the left [[hypoglossal nerve]], in which it seems to enter slightly. The left hypoglossal nerve cannot be identified. The dural thickening/tail of the tumor contacts the posterior slope of the left posterior tear, without extension to it. The lesion does not seem to have contact with the cisternal course of the left [[glossopharyngeal nerve]] and [[vagus nerve]]s, leaving these in a more cranial position to the tumor. Arachnoid cyst in the right anterior temporal pole of about 11 mm x 23 mm. 

{{::rm26102022.jpeg?800|}}

He developed a [[cerebrospinal fluid leak]], treated with [[External lumbar cerebrospinal fluid drainage]], Wound revision-Closure, [[Tachosil]] apposition and [[dural suture]].

[[External lumbar cerebrospinal fluid drainage occlusion]]
====References====