Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Conventional Posterior Approach without Far Lateral Approach for Ventral Foramen Magnum Meningiomas

  • Sohn, Seil (Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Chung, Chun Kee (Department of Neurosurgery, Seoul National University College of Medicine)
  • Received : 2013.05.21
  • Accepted : 2013.11.11
  • Published : 2013.11.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : We present our experience of conventional posterior approach without fat lateral approach for ventral foramen magnum (FM) meningioma (FM meningioma) and tried to evaluate the approach is applicable to ventral FM meningioma. Methods : From January 1999 to March 2011, 11 patients with a ventral FM meningioma underwent a conventional posterior approach without further extension of lateral bony window. The tumor was removed through a working space between the dura and arachnoid membrane at the cervicomedullary junction with minimal retraction of medulla, spinal cord or cerebellum. Care should be taken not to violate arachnoid membrane. Results : Preoperatively, six patients were of Nurick grade 1, three were of grade 2, and two were of grade 3. Median follow-up period was 55 months (range, 20-163 months). The extent of resection was Simpson grade I in one case and Simpson grade II in remaining 10 cases. Clinical symptoms improved in eight patients and stable in three patients. There were no recurrences during the follow-up period. Postoperative morbidities included one pseudomeningocele and one transient dysphagia with dysarthria. Conclusion : Ventral FM meningiomas can be removed gross totally using a posterior approach without fat lateral approach. The arachnoid membrane can then be exploited as an anatomical barrier. However, this approach should be taken with a thorough understanding of its anatomical limitation.

Keywords

References

  1. Arnautovic KI, Al-Mefty O, Husain M : Ventral foramen magnum meninigiomas. J Neurosurg 92 (1 Suppl) : 71-80, 2000
  2. 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 59 : 1177-1185; discussion 1185-1187, 2006 https://doi.org/10.1227/01.NEU.0000245629.77968.37
  3. Borba LA, de Oliveira JG, Giudicissi-Filho M, Colli BO : Surgical management of foramen magnum meningiomas. Neurosurg Rev 32 : 49-58; discussion 59-60, 2009 https://doi.org/10.1007/s10143-008-0161-5
  4. Bostrom A, Burgel U, Reinacher P, Krings T, Rohde V, Gilsbach JM, et al. : A less invasive surgical concept for the resection of spinal meningiomas. Acta Neurochir (Wien) 150 : 551-556; discussion 556, 2008 https://doi.org/10.1007/s00701-008-1514-0
  5. Boulton MR, Cusimano MD : Foramen magnum meningiomas : concepts, classifications, and nuances. Neurosurg Focus 14 : e10, 2003
  6. Bruneau M, George B : Classification system of foramen magnum meningiomas. J Craniovertebr Junction Spine 1 : 10-17, 2010 https://doi.org/10.4103/0974-8237.65476
  7. Bruneau M, George B : Foramen magnum meningiomas : detailed surgical approaches and technical aspects at Lariboisiere Hospital and review of the literature. Neurosurg Rev 31 : 19-32; discussion 32-33, 2008
  8. 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 49 : 102-106; discussion 106-107, 2001
  9. Gupta SK, Khosla VK, Chhabra R, Mukherjee KK : Posterior midline approach for large anterior/anterolateral foramen magnum tumours. Br J Neurosurg 18 : 164-167, 2004 https://doi.org/10.1080/02688690410001681028
  10. Kandenwein JA, Richter HP, Antoniadis G : Foramen magnum meningiomas--experience with the posterior suboccipital approach. Br J Neurosurg 23 : 33-39, 2009 https://doi.org/10.1080/02688690802545932
  11. 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 (Wien) 152 : 79-86; discussion 86, 2010 https://doi.org/10.1007/s00701-009-0511-2
  12. Kim CH, Chung CK : Surgical outcome of a posterior approach for large ventral intradural extramedullary spinal cord tumors. Spine (Phila Pa 1976) 36 : E531-E537, 2011 https://doi.org/10.1097/BRS.0b013e3181dc8426
  13. Klekamp J, Samii M : Surgical results for spinal meningiomas. Surg Neurol 52 : 552-562, 1999 https://doi.org/10.1016/S0090-3019(99)00153-6
  14. Kratimenos GP, Crockard HA : The far lateral approach for ventrally placed foramen magnum and upper cervical spine tumours. Br J Neurosurg 7 : 129-140, 1993 https://doi.org/10.3109/02688699309103469
  15. Margalit NS, Lesser JB, Singer M, Sen C : Lateral approach to anterolateral tumors at the foramen magnum : factors determining surgical procedure. Neurosurgery 56 (2 Suppl) : 324-336; discussion 324-336, 2005 https://doi.org/10.1227/01.NEU.0000156796.28536.6D
  16. Muhleman M, Charran O, Matusz P, Shoja MM, Tubbs RS, Loukas M : The proatlas : a comprehensive review with clinical implications. Childs Nerv Syst 28 : 349-356, 2012 https://doi.org/10.1007/s00381-012-1698-8
  17. Nakamura M, Tsuji O, Fujiyoshi K, Hosogane N, Watanabe K, Tsuji T, et al. : Long-term surgical outcomes of spinal meningiomas. Spine (Phila Pa 1976) 37 : E617-E623, 2012 https://doi.org/10.1097/BRS.0b013e31824167f1
  18. Nanda A, Vincent DA, Vannemreddy PS, Baskaya MK, Chanda A : Far-lateral approach to intradural lesions of the foramen magnum without resection of the occipital condyle. J Neurosurg 96 : 302-309, 2002 https://doi.org/10.3171/jns.2002.96.2.0302
  19. Nurick S : The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95 : 87-100, 1972 https://doi.org/10.1093/brain/95.1.87
  20. Pamir MN, Kilic T, Ozduman K, Ture U : Experience of a single institution treating foramen magnum meningiomas. J Clin Neurosci 11 : 863-867, 2004 https://doi.org/10.1016/j.jocn.2004.02.007
  21. Pirotte B, David P, Noterman J, Brotchi J : Lower clivus and foramen magnum anterolateral meningiomas : surgical strategy. Neurol Res 20 : 577-584, 1998 https://doi.org/10.1080/01616412.1998.11740567
  22. Pirotte BJ, Brotchi J, DeWitte O : Management of anterolateral foramen magnum meningiomas : surgical vs conservative decision making. Neurosurgery 67 (3 Suppl Operative) : ons58-ons70; discussion ons70, 2010
  23. Samii M, Klekamp J, Carvalho G : Surgical results for meningiomas of the craniocervical junction. Neurosurgery 39 : 1086-1094; discussion 1094-1095, 1996 https://doi.org/10.1097/00006123-199612000-00003
  24. Schaller B : Spinal meningioma : relationship between histological subtypes and surgical outcome? J Neurooncol 75 : 157-161, 2005 https://doi.org/10.1007/s11060-005-1469-4
  25. Setzer M, Vatter H, Marquardt G, Seifert V, Vrionis FD : Management of spinal meningiomas : surgical results and a review of the literature. Neurosurg Focus 23 : E14, 2007
  26. Shin H, Barrenechea IJ, Lesser J, Sen C, Perin NI : Occipitocervical fusion after resection of craniovertebral junction tumors. J Neurosurg Spine 4 : 137-144, 2006 https://doi.org/10.3171/spi.2006.4.2.137
  27. 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 35 : 359-367; discussion 367-368, 2012 https://doi.org/10.1007/s10143-012-0381-6
  28. Wang ZY, Xie JC, Ma CC, Liu B, Chen XD, Li ZD, et al. : Microsurgery on foramen magnum meningioma with suboccipital. Beijing Da Xue Xue Bao 36 : 634-636, 2004
  29. 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 72 : 376-382; discussion 382, 2009 https://doi.org/10.1016/j.surneu.2009.05.006
  30. Yoon SH, Chung CK, Jahng TA : Surgical outcome of spinal canal meningiomas. J Korean Neurosurg Soc 42 : 300-304, 2007 https://doi.org/10.3340/jkns.2007.42.4.300

Cited by

  1. Extramedullary foramen magnum tumors and their surgical management: An experience with 29 cases vol.9, pp.4, 2013, https://doi.org/10.4103/1793-5482.146616
  2. The suboccipital midline approach to foramen magnum meningiomas: safety and efficacy in a series of 23 consecutive patients over a 5-year period vol.157, pp.7, 2013, https://doi.org/10.1007/s00701-015-2438-0
  3. Cervical Spine Chondroma Compressing Spinal Cord: A Case Report and Literature Review vol.12, pp.4, 2013, https://doi.org/10.14245/kjs.2015.12.4.275
  4. Long-term recurrence rates after the removal of spinal meningiomas in relation to Simpson grades vol.25, pp.12, 2013, https://doi.org/10.1007/s00586-015-4306-2
  5. Prognostic factors affecting the surgical outcome of anterolateral benign tumors in the foramen magnum region vol.33, pp.1, 2013, https://doi.org/10.1016/j.ijsu.2016.08.011
  6. Foramen magnum meningiomas: surgical results and risks predicting poor outcomes based on a modified classification vol.126, pp.3, 2013, https://doi.org/10.3171/2016.2.jns152873
  7. Foramen magnum meningiomas: surgical results and risks predicting poor outcomes based on a modified classification vol.126, pp.3, 2013, https://doi.org/10.3171/2016.2.jns152873
  8. Technique Nuances for Functional Preservation of Lower Cranial Nerves during Surgical Management of Ventral Foramen Magnum Meningiomas Via a Dorsal Lateral Approach vol.146, pp.None, 2013, https://doi.org/10.1016/j.wneu.2020.11.140
  9. Clinical features and prognostic factors in spinal meningioma surgery from a multicenter study vol.11, pp.1, 2013, https://doi.org/10.1038/s41598-021-91225-z