title: Anterolateral meningioma of the foramen magnum and high cervical spine presenting intradural and extradural growth in a child: case report and literature review.
abstract: OBJECTIVE
  We report a rare case of anterolateral meningioma of the foramen magnum (FMM) and high cervical spine presenting both intradural and extradural growth in a 7.5-year-old boy. We also performed a review of the relevant peer-reviewed literature.
  
  
  METHODS
  The patient presented with progressive tetraparesis and gait instability. Neuroimaging revealed an anterolateral tumor of the foramen magnum, C1 and C2 cervical spine level. The patient was treated in two stages: During the first operation, the extradural part was resected while the intradural part was removed in a second operation. Following the second operation, the patient showed almost complete neurological recovery as a result of cervical spinal cord and brainstem decompression but was complicated with cerebrospinal fluid leakage and infection by Acinetobacter. He sustained two further operations for dural sealing and external ventricular drainage and was treated with intraventricular administration of antibiotics.
  
  
  RESULTS
  Histopathology of the tumor confirmed a meningotheliomatous meningioma. At the 6-month post-op follow-up examination, the patient exhibited complete neurological recovery and no radiological tumor recurrence. To the authors' best knowledge, we report the third case of sporadic pediatric meningioma of the foramen magnum and high cervical compartments with an extradural growth.
  
  
  CONCLUSIONS
  Accurate pre-operative estimation of possible extradural growth is crucial towards surgical planning and sufficient treatment. Treatment of choice is total resection in a single operating session to avoid re-operations and increased risk of complications. If not possible, a re-operation should always attempt to secure the desired result.
authors.affiliation: Department of Neurosurgery, «AHEPA» University General Hospital, Aristotle University of Thessaloniki, Stilp. Kyriakidi 1, 54636, Thessaloniki, Greece. athalkinoos@auth.gr.
authors.forename: Alkinoos
authors.initials: A
authors.lastname: Athanasiou
authors.affiliation: Department of Neurosurgery, «AHEPA» University General Hospital, Aristotle University of Thessaloniki, Stilp. Kyriakidi 1, 54636, Thessaloniki, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Magras
authors.affiliation: Department of Neurosurgery, «AHEPA» University General Hospital, Aristotle University of Thessaloniki, Stilp. Kyriakidi 1, 54636, Thessaloniki, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Sarlis
authors.affiliation: Department of Neurosurgery, «AHEPA» University General Hospital, Aristotle University of Thessaloniki, Stilp. Kyriakidi 1, 54636, Thessaloniki, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Spyridopoulos
authors.affiliation: Department of Neurosurgery, «AHEPA» University General Hospital, Aristotle University of Thessaloniki, Stilp. Kyriakidi 1, 54636, Thessaloniki, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Polyzoidis
mesh_terms: D002574:Cervical Vertebrae / Q000473:pathology; D002648:Child; D005500:Follow-Up Studies; D005539:Foramen Magnum / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D013118:Spinal Cord Diseases / Q000209:etiology* / Q000473:pathology*
keywords: Child; Craniocervical junction; Extradural meningioma; Foramen magnum meningioma; Pediatric