title: Foramen magnum meningioma: The midline suboccipital subtonsillar approach.
abstract: OBJECTIVE
  Foramen magnum meningiomas (FMMs) represent a technical challenge even for experienced neurosurgeons, because they grow in close contact with osteoarticular, nervous, and vascular structures that cannot be sacrificed or retracted during surgery. Our goal is to present our experience with 24 cases of surgically resected foramen magnum meningiomas used the midline suboccipital subtonsillar approach and discussed the present risks associated with the treatment of this condition.
  
  
  METHODS
  We retrospectively reviewed all patients who underwent surgery treatment for foramen magnum meningiomas operated on between August 2005 and July 2013. A total of 24 cases were included. Data regarding age, sex, symptoms and sign types, locations, surgical aspects, postoperative new deficits, and follow-up are presented.
  
  
  RESULTS
  There were 18 female and 6 male patients (mean age: 52 years). The symptom among most patients (14 patients) was cervico-occipital pain, dysphagia and gait unsteadiness in five, and paresthesia of the upper limbs in four. Total removal of the tumor was achieved in 20 patients, subtotal in two, and partial resection in four patients. Two patients had permanent deficits. Follow-up was 45.6 months (range, 6 months to 8 years), there was no recurrence among tumors totally removed but 1 patient of regrowth among the cases with subtotal removal.
  
  
  CONCLUSIONS
  Our experience confirmed that the midline suboccipital subtonsillar approach was accurate in safely removing anterior, anterolateral, and posterior FMMs. There was no significant postoperative complication in the remainder of the patientes, and their conditions improved after surgery.
authors.affiliation: Department of Neurosurgery, Eberhard Karl University, Tübingen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Dobrowolski
authors.affiliation: Department of Neurosurgery, Eberhard Karl University, Tübingen, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Ebner
authors.affiliation: Department of Neurosurgery, Eberhard Karl University, Tübingen, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Lepski
authors.affiliation: Department of Neurosurgery, Eberhard Karl University, Tübingen, Germany. Electronic address: marcos.tatagiba@med.uni-tuebingen.de.
authors.forename: M
authors.initials: M
authors.lastname: Tatagiba
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005539:Foramen Magnum / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008579:Meningioma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Foramen magnum; Posterior fossa meningioma; Skull base; Surgical approach