Far-Lateral Approach for Foramen Magnum Meningioma: An Anatomical Study with Special Reference to Bulbopontine Junction

Abstract

Intracranial meningiomas are sometimes located anteriorly to the foramen magnum and can cause disabling long tract symptoms. The far-lateral approach has been developed to provide an extensive view over the bulbopontine junction and the surrounding lower cranial nerves and upper spinal nerves with a good control on the vertebral artery, allowing the safe resection of such tumors. It is the report of a case with anatomical study before and after the removal of the meningioma. The use of the far-lateral approach allowed us to (1) control the vertebral artery in its V3 (Atlantic extradural) and V4 (intradural) portion (2) have an optimal visibility on the lower cranial nerves, the upper spinal nerves, and the bulbopontine junction, and (3) perform a Simpson 2 resection of the tumor that was inserted between the lower clivus and the upper odontoid process. Beyond its interest for the safe resection of tumors located anteriorly to the foramen magnum, the far-lateral approach is of particular anatomical interest. It allowed us to review the anatomy of the craniocervical junction.

Total resection of foramen magnum meningioma via a far-lateral approach – a case report

“…Compared with the far-lateral approach, the extreme-lateral approach requires more time and more extensive condylectomy, which increases the risk of craniocervical junction instability. 12 Moreover, postoperative complications such as CSF leakage and lower cranial nerve damage were more commonly observed in the extreme-lateral approach than in the far-lateral approach. 12 On the other hand, the extreme-lateral approach provides an extended surgical corridor and increased exposure compared with the far-lateral approach.…”

“…12 Moreover, postoperative complications such as CSF leakage and lower cranial nerve damage were more commonly observed in the extreme-lateral approach than in the far-lateral approach. 12 On the other hand, the extreme-lateral approach provides an extended surgical corridor and increased exposure compared with the far-lateral approach. 2 In our case, the far-lateral approach was implemented due to anterolateral localization of the tumor with achieving Simpson grade 1 and recurrence-free survival.…”

Combined Deficit of the Four Lower Cranial Nerves also Known as the Syndrome of Collet-Sicard: A Systematic Review and Meta-analysis

“…Precise knowledge of this region's surgical anatomy is a prerequisite in order to perform functional sparing surgery, given the proximity of the bulbospinal junction, the presence of the vertebral artery, and the lower CNs. 87 Beyond its wellknown complications such as intracranial infection and cerebrospinal fluid leak, the surgical procedure in itself may worsen the CN deficits. [88][89][90] Given these considerations, palliative radiotherapy may appear as a valuable alternative, even more in case of very aggressive tumors or multimetastatic patients.…”