title: Foramen magnum meningiomas: To drill or not to drill the occipital condyle? A series of 12 patients.
abstract: BACKGROUND
  Despite the development of microsurgery and cranial base techniques, the surgical management of Foramen Magnum Meningiomas (FMM) continues to be a technical challenge to neurosurgeons. Controversy concerning the utility of systematic condyle drilling for approaching FMM has been raised. Our aim was to describe the surgical technique, analyze its safety, and the postoperative outcome in 12 consecutive FMM patients.
  
  
  METHODS
  From 1986 to 2011, 12 patients with FMM underwent operations in the Department of Neurosurgery at Servidores do Estado Hospital and in a private clinic. All patients were operated using a standard suboccipital craniectomy, preserving the occipital condyle, opening of the Foramen Magnum, and ipsilateral removal of the posterior arch of C1.
  
  
  RESULTS
  There was no operative mortality, nine patients achieved Glasgow Outcome Scale 4 or 5. Condylar resection was not deemed necessary in any case. Gross total resection was achieved in nine patients. After surgery, four patients developed lower cranial nerve weakness. There was no significant postoperative complication in the remaining patients. The average follow-up is 8.2 years.
  
  
  CONCLUSIONS
  The vast majority of FMM can be safely removed with a retrocondylar lateral suboccipital approach without condylar resection, using meticulous microsurgical techniques.
authors.affiliation: Head of the Neurosurgical Department, Servidores do Estado Hospital, Rio de Janeiro, RJ, Brazil.
authors.forename: Jose Carlos
authors.initials: JC
authors.lastname: Lynch
authors.forename: Vicente
authors.initials: V
authors.lastname: Temponi
authors.forename: João Cláudio
authors.initials: JC
authors.lastname: Emmerich
authors.forename: Celestino Esteves
authors.initials: CE
authors.lastname: Pereira
authors.forename: Mariangela Barbi
authors.initials: MB
authors.lastname: Gonçalves
keywords: Foramen magnum; foramen magnum meningiomas; meningiomas; microsurgery; retrocondylar suboccipital approach