title: Foramen magnum meningiomas: clinical outcome after microsurgical resection via a posterolateral suboccipital retrocondylar approach.
abstract: OBJECTIVE
  We analyzed a consecutive series of patients operated for a foramen magnum (FM) meningioma located on the ventral aspect of the medulla oblongata via a posterolateral suboccipital retrocondylar approach with regard to long-term surgical outcome.
  
  
  METHODS
  Clinical data in a consecutive series of 25 patients experiencing a meningioma attached to dura of the anterior or anterolateral FM rim were retrospectively reviewed.
  
  
  RESULTS
  The most common symptoms of the 19 women and six men (mean age, 59.2 yr) was cervico-occipital pain (72%) and gait disturbance (32%). Clinical examination revealed gait ataxia in 48% of the patients. As depicted from preoperative magnetic resonance imaging (MRI), dural attachment of the meningioma at the FM rim was anterior in 36% and anterolateral in 64% of cases. Tumor removal was accomplished via a posterolateral suboccipital retrocondylar approach in all patients. A Simpson Grade 2 resection was achieved in 96% of the patients. Permanent surgical morbidity and mortality rates were 8 and 4%, respectively. No tumor recurrence was observed after a mean follow-up period of 6.1 years (range, 1-14 yr) with clinical and MRI examination, and 80% of the patients have regained full daily activity.
  
  
  CONCLUSIONS
  Anterior and anterolateral FM meningiomas that displace the medulla/spinal cord can be safely and completely resected via a posterolateral suboccipital retrocondylar approach. A tumor remnant should be left on critical neurovascular structures in cases with poor arachnoid dissection planes.
authors.affiliation: Department of Neurosurgery, University Hospital Essen, Essen, Germany. hibassiouni@yahoo.de
authors.forename: Hischam
authors.initials: H
authors.lastname: Bassiouni
authors.forename: Vasilios
authors.initials: V
authors.lastname: Ntoukas
authors.forename: Siamak
authors.initials: S
authors.lastname: Asgari
authors.forename: Erol I
authors.initials: EI
authors.lastname: Sandalcioglu
authors.forename: Dietmar
authors.initials: D
authors.lastname: Stolke
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005539:Foramen Magnum / Q000601:surgery*; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009777:Occipital Bone / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome