Browse > Article
http://dx.doi.org/10.3340/jkns.2013.54.5.373

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)
Publication Information
Journal of Korean Neurosurgical Society / v.54, no.5, 2013 , pp. 373-378 More about this Journal
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
Foramen magnum; Meningioma; Surgery;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 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   DOI   ScienceOn
2 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
3 Yoon SH, Chung CK, Jahng TA : Surgical outcome of spinal canal meningiomas. J Korean Neurosurg Soc 42 : 300-304, 2007   DOI   ScienceOn
4 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   DOI   ScienceOn
5 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   DOI
6 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   DOI   ScienceOn
7 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   DOI
8 Pamir MN, Kilic T, Ozduman K, Ture U : Experience of a single institution treating foramen magnum meningiomas. J Clin Neurosci 11 : 863-867, 2004   DOI   ScienceOn
9 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   DOI   ScienceOn
10 Nurick S : The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95 : 87-100, 1972   DOI   ScienceOn
11 Pirotte B, David P, Noterman J, Brotchi J : Lower clivus and foramen magnum anterolateral meningiomas : surgical strategy. Neurol Res 20 : 577-584, 1998   DOI
12 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
13 Schaller B : Spinal meningioma : relationship between histological subtypes and surgical outcome? J Neurooncol 75 : 157-161, 2005   DOI
14 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
15 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   DOI   ScienceOn
16 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   DOI
17 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   DOI   ScienceOn
18 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   DOI
19 Bruneau M, George B : Classification system of foramen magnum meningiomas. J Craniovertebr Junction Spine 1 : 10-17, 2010   DOI   ScienceOn
20 Boulton MR, Cusimano MD : Foramen magnum meningiomas : concepts, classifications, and nuances. Neurosurg Focus 14 : e10, 2003
21 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
22 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
23 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   DOI   ScienceOn
24 Kandenwein JA, Richter HP, Antoniadis G : Foramen magnum meningiomas--experience with the posterior suboccipital approach. Br J Neurosurg 23 : 33-39, 2009   DOI   ScienceOn
25 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   DOI
26 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   DOI   ScienceOn
27 Klekamp J, Samii M : Surgical results for spinal meningiomas. Surg Neurol 52 : 552-562, 1999   DOI   ScienceOn
28 Samii M, Klekamp J, Carvalho G : Surgical results for meningiomas of the craniocervical junction. Neurosurgery 39 : 1086-1094; discussion 1094-1095, 1996   DOI   ScienceOn
29 Arnautovic KI, Al-Mefty O, Husain M : Ventral foramen magnum meninigiomas. J Neurosurg 92 (1 Suppl) : 71-80, 2000
30 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   DOI   ScienceOn