Foramen magnum meningioma surgery complications

Morbidity after resection of FM meningiomas includes lower CN deficits, hemiparesis, tetraparesis, sensory deficits, hydrocephalus, craniospinal fluid leak, meningitis, and general complications such as pneumonia, and respiratory failure. In the last two decades, transient and permanent morbidity ranged from 0-72.5%

There were 38 complications in 12 patients (43%), and 6 patients (21%) had complications requiring additional surgery. Complications included cerebrospinal fluid leak/hydrocephalus ( n = 7, 25%), weakness ( n = 4, 14%), numbness ( n = 4, 14%), and cranial nerve deficits: IX, X ( n = 4, 14%), XI ( n = 2, 7%), XII ( n = 5, 18%). Medical complications included pneumonia ( n = 1, 4%) and meningitis ( n = 1, 4%). Tumor volume greater than 14 cm 3 (odds ratio [OR] = 21.7, p = 0.0010), any vertebral artery encasement (OR 6.1, p = 0.0386), and subtotal resection (OR 6.4, p = 0.0398) were significantly associated with complications ¹⁾.

The most frequent postoperative complications were temporary lower cranial nerve (CN IX and X ) palsy in 2 anterior localized cases (18%) and also cerebrospinal fluid (CSF) fistula in a 1 anterior localized case with difficulty in swallowing (dysphagia). ²⁾.

Li D, Wu Z, Ren C, Hao SY, Wang L, Xiao XR, Tang J, Wang YG, Meng GL, Zhang LW, Zhang JT. Foramen magnum meningiomas: surgical results and risks predicting poor outcomes based on a modified classification. J Neurosurg. 2017 Mar;126(3):661-676. doi: 10.3171/2016.2.JNS152873. Epub 2016 May 13. Erratum in: J Neurosurg. 2017 Mar;126(3):1017. PMID: 27177171.

The ovoid FM group had lower volumetric extents of resection without statistical significance (93 ± 10 vs. 100 ± 0%, p = 0.069), more intraoperative blood loss (319 ± 75 vs. 219 ± 75 mL, p = 0.019), more complications per patient (1.9 ± 1.8 vs. 0.3 ± 0.4, p = 0.039), and poorer postoperative KPS (80 ± 21 vs. 96 ± 5, p = 0.007). Hypoglossal nerve palsy was more frequent in the ovoid FM group (38 vs. 13%). Conclusion This is the first study demonstrating that ovoid FMs may pose surgical challenges, poorer operative outcomes, and lower rates of extent of resection. Preoperative radiological investigation including morphometric FM measurement to determine if FMs are ovoid or nonovoid can improve surgical planning and complication avoidance ³⁾.

Cerebrospinal fluid fistula after foramen magnum meningioma surgery

¹⁾

Magill ST, Shahin MN, Lucas CG, Yen AJ, Lee DS, Raleigh DR, Aghi MK, Theodosopoulos PV, McDermott MW. Surgical Outcomes, Complications, and Management Strategies for Foramen Magnum Meningiomas. J Neurol Surg B Skull Base. 2019 Feb;80(1):1-9. doi: 10.1055/s-0038-1654702. Epub 2018 May 28. PMID: 30733894; PMCID: PMC6365236.

²⁾

Bilgin E, Çavus G, Açik V, Arslan A, Olguner SK, Istemen I, Gezercan Y, Ökten AI. Our surgical experience in foramen magnum meningiomas: clinical series of 11 cases. Pan Afr Med J. 2019 Sep 3;34:5. doi: 10.11604/pamj.2019.34.5.17536. PMID: 31762874; PMCID: PMC6850739.

³⁾

Kina H, Erginoglu U, Hanalioglu S, Ozaydin B, Baskaya MK. Ovoid Foramen Magnum Shape is Associated with Increased Complications and Decreased Extent of Resection for Anterolateral Foramen Magnum Meningiomas. J Neurol Surg B Skull Base. 2020 Oct 5;82(6):682-688. doi: 10.1055/s-0040-1715559. PMID: 34745837; PMCID: PMC8563267.