Foramen magnum meningiomas: surgical treatment in a single public institution in a developing country

Abstract

Objective: To analyze the clinical outcome of patients with foramen magnum (FM) meningiomas. Method: Thirteen patients (11 Feminine / 2 Masculine with FM meningiomas operated on through lateral suboccipital approach were studied. Clinical outcome were analyzed using survival (SC) and recurrence-free survival curves (RFSC). Results: All tumors were World Health Organization grade I. Total, subtotal and partial resections were acchieved in 69.2%, 23.1% and 7.7%, respectively, and SC was better for males and RFSC for females. Tumor location, extent of resection and involvement of vertebral artery/lower cranial nerves did not influence SC and RFSC. Recurrence rate was 7.7%. Operative mortality was 0. Main complications were transient (38.5%) and permanent (7.7%) lower cranial nerve deficits, cerebrospinal fluid fistula (30.8%), and transient and permanent respiratory difficulties in 7.7% each. Conclusions: FM meningiomas can be adequately treated in public hospitals in developing countries if a multidisciplinary team is available for managing postoperative lower cranial nerve deficits.Keywords: foramen magnum meningiomas, surgical treatment, extent of resection, survival, postoperative complications. RESUMOObjetivo: Analisar as evoluções clínicas de 13 pacientes com meningiomas do forame magno (FM). Método: Foram estudados 13 pacientes com meningiomas do FM (11 Feminino / 2 Masculino) operados por abordagem suboccipital lateral. As evoluções clínicas foram analisadas usando curvas de sobrevida (SC) e de sobrevida livre de doença (RFSC). Resultados: Os 13 tumores eram Grau I da Organização Mundial de Saúde. Ressecções total, subtotal and parcial foram obtidas em 69,2%, 23,1 e 7,7%, respectivamente. A SC foi melhor para homens e a RFSC foi melhor para mulheres. Localização/ extensão da ressecção/envolvimento da artéria vertebral/nervos cranianos baixos não influenciaram a SC/RFSC. A taxa de recorrência foi 7,7%. A mortalidade operatória foi zero. As principais complicações foram déficits de nervos cranianos baixos transitórios (38,5%) e permanentes (7,7%); fístula de líquido cefalorraquidiano (30,8%) e dificuldades respiratórias transitórias e permanentes em 7,7% cada. Conclusões: Meningiomas do FM podem ser adequadamente tratados em hospitais públicos em países em desenvolvimento se houver uma equipe multidisciplinar para cuidar de déficits de nervos cranianos baixos pós-operatórios.Palavras-chave: meningiomas do forame magno, tratamento cirúrgico, extensão da ressecção, sobrevida, complicações pós-operatórias.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

Foramen Magnum Meningioma: a Case Report and Review of Literature

“…The spinal dentate ligament delineates the anterior and posterior compartments but there is a report of meningioma originating from the dentate ligament ( 20 ). Anterior and lateral FMMs are more frequent than posterolateral FMMs ( 5 , 6 , 8 , 19 ). FMMs having the possibility to develop above, below, and on both sides of the VA. Meningiomas are more often located below the VA.…”

“…FMM 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 ( 7 - 9 ). The mean age of the patients with these lesions at the time of diagnosis is approximately 55 years old, but these tumors have been reported in patients of almost every age ( 5 , 6 , 10 - 12 ). Although a FMM occurs in children ( 13 ).…”

“…The first category of the symptoms includes occipital and posterior cervical pain and hyperesthesia in the C2 dermatome ( 5 , 10 , 24 - 28 ). This pain is the most salient initial manifestation of the tumor, usually exacerbated by neck manipulation or by maneuvers that raise the intracranial pressure, such as coughing, straining, or sneezing( 21 , 29 ).…”

“…An estimated 1-2% of the population has incidental asymptomatic meningiomas, and in autopsy studies 8% of these are multiple. The vast majority of meningiomas are benign, slow growing tumors that occur more frequently in women ( 3 - 5 ). The 2:1 female/male ratio observed for intracranial meningiomas is consistent with the increased incidence of meningiomas in post-menopausal women treated with exogenous hormone replacement ( 6 ).…”

“…Foramen magnum meningiomas (FMMs) represent a common histological tumor in a rare and eloquent location. As these tumors are indolent, there occurs a long interval between onset of symptoms and diagnosis ( 3 - 5 ). We report a case of FMM in male patient who presented with ataxia and sense of threatening fainting during verticalization.…”