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

Abstract

ObjectiveWe 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.MethodsFrom 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.ResultsPreoperatively, 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.ConclusionVentral 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.

Long-term recurrence rates after the removal of spinal meningiomas in relation to Simpson grades

“…The tumors were located on the cervical spine in eight patients (ventral, 4; lateral, 3; dorsal, 1) and on the thoracic spine in 12 (ventral, 5; lateral, 6; dorsal, 1) ( Table 3). The largest diameter among the tumors was 15.9 ± 5.0 mm (range [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25], and the dural tail sign was present in 15/20 patients.…”

“…All operations were performed using the conventional posterior midline approach and laminectomy beyond the rostral and caudal ends of the tumor to minimize kinking of the spinal cord by laminotomy and to expose the proximal and distal subarachnoid space for the dissection to begin [4,15,23]. Facetectomy and/or costotransversectomy was not a routine procedure.…”

Morphological Analysis of Occipital Condyles and Foramen Magnum as a Guide for Lateral Surgical Approaches

“…It has several advantages-there is no need for drilling the OCs or lateral mass, and postoperative recovery is fast [27]. This approach can be divided into posterior suboccipital, posterolateral (lateral suboccipital), far lateral [23], standard para median suboccipital and transcondylar approaches [28,29].…”

The suboccipital midline approach to foramen magnum meningiomas: safety and efficacy in a series of 23 consecutive patients over a 5-year period

“…The mean hospital stay was 16 days (range, 9-37 days). Published literature on MSO approach for FM meningiomas reports similar data [4,5]; these series are all about meningioma of small to medium size. In this sense, we suppose that it could be misleading to state that the MSO approach is more adequate for larger FM meningiomas.…”