FORAMEN MAGNUM MENINGIOMA

Foramen Magnum Meningioma

The foramen magnum is the opening in the skull that communicates the intracranial compartment to the cervical spine compartment. When the brainstem passes through the foramen magnum it becomes the uppermost spinal cord. Meningiomas arising at the foramen magnum compress the brainstem and upper cervical spinal cord and engulf the vertebral artery which provides blood supply to the parts of the brain in the back of the head.

Foramen Magnum Meningioma Symptoms

Foramen magnum Meningiomas tend to present initially with headaches in the back of the head. As the tumor progresses, it compresses the brainstem and the spinal cord and it can cause motor weakness. The weakness can be unilateral or bilateral involving the upper and lower exterminates or involving only both upper extremities. The patient can also develop numbness in the upper and lower extremities. With further progression, the patient can become bedridden with quadriplegia and swallowing difficulties.

Meningioma Treatment

Symptomatic foramen magnum Meningiomas, in general, need surgical intervention. Smaller tumors may be treated primarily with CiberKnife radiation therapy or Proton bean Radiation Therapy. Incidental tumors in elderly patients may be managed with observation with surveillance MRIs.

Surgical Treatment at the Meningioma Center

Foramen magnum Meningioma is approached through a unilateral craniotomy around the foramen magnum and a unilateral laminectomy of the first vertebra to access the confined area of the foramen magnum. At the Meningioma Center, we refined a focused approach through a lazy S incision in the back of the head. The approach allows extradural access to the origin of the tumor without retraction, or manipulation of the brainstem, spinal cord, or cerebellum. The approach allows for the vertebral artery to be identified prior to any removal of the tumor enhancing safe tumor dissection without injury to this main artery to the brain. Moreover, it offers the potential for complete resection of the tumor including the meningeal root of the tumor.

Foramen Magnum Meningioma Prognosis

Treatment of foramen magnum Meningiomas through a focused combined Cervico-foramen magnum approach enhances the chances of total tumor removal, tumor cure, and the possibility of recovery from preoperative deficits. Moreover, patients have the potential for returning to their lifestyle and job occupation. Maximal removal of the tumor and its meningeal root maximizes the chances of the tumor not recurring.