Thieme ejournals journal of neurological surgery part b. The suboccipital midline approach to foramen magnum. Early diagnosis of cervical spinal cord meningioma jama. In this clinical report of 14 patients, we describe a novel imaging finding within the foramen magnum. Imaging workup was highly suggestive of an fm meningioma. Meningioma in the foramen magnum area of brain brain.
The neurosurgical atlas is committed to promoting neurosurgical education free of charge. Foramen magnum meningiomas start off in the hole in the base of the skull that the spinal cord passes through called the foramen magnum. 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. The acoustic neurinoma is the second in frequency, and meningiomas the third. We report a series of patients with foramen magnum meningioma treated in our institution. There were 68 female and 46 male patients mean age, 52. Sx are related to tumor growth and compression prognosis 5yr survival 70%.
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. F oramen magnum meningiomas fmms represent only 2%3% of all meningiomas but nearly 75% of all benign extramedullary lesions at the foramen magnum. Foramen magnum fm meningiomas account for approximately 1. 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. We present the case of a 38yearold female with neck pain, dysphonia, and. We report a classification system based on our experience of 107 tumors. People with meningioma may experience the following symptoms or signs.
Sometimes, people with meningioma do not have any of these changes. Symptoms typically appear gradually and vary depending on the tumor location. Anteriorly placed meningiomas at the level of the foramen magnum are rare, are difficult to diagnose, and present technical problems for a convention. Far lateral approach to intradural lesions of the foramen magnum without resection of the occipital condyle. The foramen magnum is an uncommon location for lesions which require an anterior approach. Figure 441 mri is the diagnostic study of choice for foramen magnum meningiomas providing information both for differential diagnosis and surgical planning. It is one of the several oval or circular openings foramina in the base of the skull. In 1938, cushing reported his own experience with 3 cases of meningioma operated in the early 20th century. Intradural extramedullary foramen magnum enhancing lesions may be due to meningioma, nerve sheath tumor, aneurysm, or meningeal disease. Outcomes of stereotactic radiosurgery for foramen magnum. Far lateral approach for resection of a foramen magnum. 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.
Classification, foramen magnum, meningioma, surgical approach, tumor. Even for the most experienced neurosurgeons, foramen magnum meningiomas represent a surgical challenge owing to their delicate position surrounded by the brainstem, lower cranial nerves, and vertebral arteries. Original article efficiency of posterior approach for ventral. Located near the opening at the base of the skull through which the lower portion of the brainstem passes. Insidious presentation of a foramen magnum meningioma. Think of that menu as a roadmap for this complete guide.
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. Department of neurosurgery, metropolitan hospital, athens, greece. Foramen magnum meningiomas are challenging tumors, requiring special considerations because of the vicinity of the medulla oblongata, the lower cranial nerves, and the vertebral artery. Oponiak w otworze potylicznym wielkim foramen magnum. Pdf meningioma of foramen magnum causing drop attacks. Classification system of foramen magnum meningiomas. Resultsthere were 6 female and 4 male patients mean age 41. Nanda a, vincent da, vannemreddy ps, baskaya mk, chanda a. The pathologic entity of fmm was first described in 1872. Fifteen of these cases were cerebellar convexity meningiomas. Tumors of the foramen magnum and the upper part of the cervical spinal cord are often initially seen with confusing clinical syndromes that are frequently ascribed to a conversion hysteria or fibromyositis. Foramen magnum fm meningiomas are challenging lesions. Apr 29, 2016 surgical excision of foramen magnum meninigioma brain tumor at apollo speciality hospital, chennai. Gliomas are the commonest neoplasm occurring in the posterior fossa.
A survey of the literature up to 1937 reveals only 14 cases with. A 58yearold woman presented with an 18month history of progressive dysphagia, chronic cough and 30pound. I am now having surgery for a meningioma in my left frontal lobe on 72620, compared to the 1sr surgery this one should be much easier. Most meningiomas are benign not cancer and slow growing. We present the case of a 38yearold female with neck pain, dysphonia, and slight twelfth nerve palsy. Although meningiomas account for a sizable proportion of all primary intracranial neoplasms 14. Located in the fluid chambers that produce and carry cerebrospinal fluid throughout the brain. The advantages of a posterior conventional suboccipital approach with a midline incision over lateral, anterolateral, and anterior approac. A sphenoid ridge meningioma is found along the ridge of bone behind the eyes and nose. Some meningiomas can cause problems despite their benign nature, because they are difficult to remove when they are located in. These tumors may extend for a considerable distance up the clivus or. Olfactory groove meningiomas grow near the olfactory nerve, located between the brain and the nose. Classification system of foramen magnum meningiomas ncbi.
Meningiomas classifications, risk factors, diagnosis and. Panagiotis zogopoulos, anastasios venetikidis, georgios vretakos and dimitrios rologis. A meningioma is a tumor that grows from the meninges the protective membranes that cover the brain and spinal cord. Symptoms depend on the location and occur as a result of the tumor pressing on nearby tissue.
You will find out more about body changes and other things that can signal a problem that may need medical care. The appreciation of such an association may be of diagnostic value. Meningeal tumor obstructing the foramen magnum is relatively rare and until recently has seldom been diagnosed ante mortem. 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.
Meningiomata definition of meningiomata by medical dictionary. We present a case of a foramen magnum meningioma that highlights the importance of the neurologic exam when evaluating a patient with dysphagia. A retrospective study was performed of 18 patients who harbored a meningioma in the ventral foramen magnum mean followup period, 40 months and underwent surgery via a transcondylar approach. Della puppa and colleagues describe a midline suboccipital approach for an anterolaterally located foramen magnum meningioma. 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. Foramen magnum meningiomas are rare tumors, accounting for only 0. The second most frequent location for meningiomas of the posterior fossa is on the anterior rim of the foramen magnum.
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. Foramen magnum meningioma may rarely present with drop attacks and should be considered in the differential diagnosis of the conditions causing drop attacks. Tumors of the spinal cord which project into the posterior cranial fossa. The spinal cord, an extension of the medulla oblongata, passes through the foramen magnum as it exits the cranial cavity. The three main algorithm criteria included the compartment of development of the tumor, its dural insertion, and its relation.
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. Microsurgical resection of foramen magnum meningioma. It is opposite to and compressing the cervicomedullary junction of the spinal cord and displacing it to the anterolateral aspect of the foramen magnum. Although not technically a brain tumor, it is included in this category because it may compress or squeeze the adjacent brain, nerves and vessels. Endoscopic endonasal approach to foramen magnum meningioma. Tumours in the region of foramen magnum pages with reference to book, from 119 to 122 naimurrahman department of neurosurgery, rawalpindi medical college, rawalpindi. Midline suboccipital subtonsillar approach with c1 laminectomy for resection of foramen magnum meningioma. Meningiomas are slowgrowing benign tumors that arise at any location where arachnoid cells reside. Foramen magnum meningiomas represent a common histological tumor in a rare and eloquent location. Preoperative and postoperative contrastenhanced t1weighted images demonstrate the ventrally located foramen magnum meningioma between two intradural vertebral arteries. Surgical treatment of ventral foramen magnum meningiomas.
Intraventricular chordoid meningioma presenting with castleman disease due to overproduction of interleukin6. It has caused compression of the spinal cord so i had no other options. Multiple surgical strategies have been reported to treat these lesions in their variable location. Meningiomas, meningioma brain tumor mayfield clinic. Conclusion a large subset of foramen magnum meningiomas harbor akt1 e17k mutations and are therefore potentially amenable to targeted medical therapy. Experience of a single institution treating foramen magnum meningiomas.
Clinical information was extracted from the chart using electronic medical records, radiology. Ventral foramen magnum meningiomas can be radically resected in a majority of patients, with frequent but transient morbidity caused by lower cranial nerve deficits. Meningioma of the foramen magnum when unrecognised may lead to progressive myelopathy with quadriplegia, dysphagia, and sphincter disturbance. Foramen magnum meningioma suboccc1 laminectomy youtube. A meningioma can be either benign noncancerous or malignant cancerous. Located centrally in the posterior fossa is the foramen magnum which is the large opening at the base of the skull through which the spinal cord becomes continuous with the medulla oblongata part of the brainstem. Her mri brain showed large foramen magnum tumor extending upto c2. Or, the cause of a symptom may be a different medical condition that is not a tumor. Posterior fossa meningiomas include tentorial, clival, cerebellopontine angle and foramen magnum meningiomas. You will find some basic information about this disease and the parts of the body it may affect. Versatility of suboccipital approach for foramen magnum.
Meningioma is the most common type of tumor that forms in the head. Oponiak w otworze potylicznym wielkim foramen magnum meningioma. I was in hospital about 18 dys and had fully recovered. Pdf genomic analysis of posterior fossa meningioma. Although meningiomas account for almost 20% of brain tumors, only 1. Anatomy the occipital bone surrounds the foramen magnum and is composed of. Over a 5year period, 15 patients presenting with meningiomas of the foramen magnum. I had a schwonnoma tumor removed from the foramen magnum in nov 2004.
Ppt foramen magnum meningioma powerpoint presentation. Foramen magnum meningiomas were classified as anterior 80 cases, anterolateral 24 cases, and. Microsurgical gross total resection of foramen magnum. Foramen magnum meningioma surgical neurology international. 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. Tailored far lateral approach to anterior foramen magnum. Over a 5year period, 15 patients presenting with meningiomas of the foramen magnum underwent surgical treatment. Insidious presentation of a foramen magnum meningioma a case report. Foramen magno meningioma removed by a transcondylar approach. Transoral transclival removal of anteriorly placed meningiomas at.
A meningioma is a tumor that grows in the membranes that surround your brain and spinal cord, known as the meninges. Foramen magnum meningiomas are rare, their diagnosis and treatment are difficult, and surgical results are generally worse than for other meningiomas and complication rate is high. The present communication concerns the appearance of a meningioma in a patient from whom a. Surgical footage of resection of a complex brain tumor meningioma abutting the motor cortex by dr. Meningiomas of the posterior cranial fossa radiology. 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. Foramen magnum meningiomas experience with the posterior. Surgery on anterior foramen magnum meningiomas using a. Microsurgical endoscopiccontrolled resection via a lateral suboccipital retrocondylar approach with. Foramen magnum meningiomas fmms are challenging tumors.
Apr 21, 2020 a meningioma is a tumor that arises from the meninges the membranes that surround your brain and spinal cord. Our goal is to present our experience with 24 cases of surgically resected foramen magnum meningiomas used the midline suboccipital subtonsillar approach and discussed the present risks associated with the treatment of this condition. Pheochromocytoma and meningioma of the foramen magnum. Lifestyle full video amrit maan ft gurlej akhtar latest punjabi songs 2020new punjabi songs 2020 duration. Microsurgical resection is the treatment of choice in newly diagnosed foramen magnum meningiomas. Insidious presentation of a foramen magnum meningioma a. Inflammatory response and meningioma tumorigenesis and the effect of cyclooxygenase2 inhibitors. Dorsal foramen magnum mass is seen compressing the cervicomedullary junction and upper cervical cord. Microsurgical gross total resection of foramen magnum meningioma via far lateral approach. The websites for mass effect, mass effect 2, and mass effect 3 are no longer available. Right axial t1weighted gdenhanced mr image obtained at the level of the foramen magnum. When these tumors occur in the skull base, near structures called the cavernous sinus, petrous bone, clivus or posterior fossa, they can encircle blood.
Foramen magnum meningiomas are the most common tumor we have addressed via this approach. 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. The aim of this study is to analyse short and longterm results after surgical treatment of foramen magnum meningiomas and to identify the possible advantages. Surgical management of foramen magnum meningiomas springerlink. In this paper professor george details his experience and understanding of the different types of foramen magnum meningiomas. Foramen magnum meningiomas fmm represent a challenge for neurosurgeons. Insidious presentation of a foramen magnum meningioma a case report panagiotis zogopoulos, anastasios venetikidis, georgios vretakos and dimitrios rologis department of neurosurgery, metropolitan hospital, athens, greece abstract foramen magnum meningiomas. 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. There is no charge to read or download any sni content, but registering for a free membership will provide you with additional special features.