Skip to main content

Advertisement

SpringerLink
Log in

Microsurgical resection of foramen magnum meningioma: multi-institutional retrospective case series and proposed surgical risk scoring system

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

Foramen magnum meningiomas (FMMs) are a major surgical challenge, due to relevant surgical morbidity and mortality. The paper aims to review the clinical (symptomatic improvement, complication rate, length of hospital stay) and radiological outcome (completeness of resection) of microsurgical resection of FMMs, and to identify predictors of complications.

Methods

A multi-institutional retrospective review of prospectively maintained database of FMMs included 51 patients (74.5% females) with a median tumor volume of 8.18 cm3 (range, 1.77–57.9 cm3) and median follow-up of 36 months (range, 0.30–180.0 months). Tumors were resected though suboccipital approach (58.8%) or posterior-lateral approaches (39.3%), including far-lateral, extreme lateral and transcondylar approaches.

Results

Gross-total resection (GTR) was achieved in 80.4% and 98% of cases did not present tumor regrowth or recurrence. Clinical symptoms improved in 34 patients (66.7%) and worsened in 5 (9.8%). The median length of hospital stay was 5 days. Mortality was null. Postoperative complications developed in 15 patients (29.4%), with cerebrospinal fluid leak (7.8%) and lower cranial nerves deficits (7.8%) as the most frequent. Craniospinal location (p = 0.03), location anterior to the dentate ligament (DL) (p = 0.02), involvement of vertebral artery (VA) (p = 0.03) were significantly associated with complication rate. These three elements allow calculating the Foramen Magnum Meningioma Risk Score (FRMMRS), to estimate the risk of post-operative complications.

Conclusion

Microsurgical resection allows for high GTR rate and low rate of tumor regrowth or recurrence, despite complications in one third of the patients. The FMMRS allows classifying FMMs and estimating the risk of post-operative complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

Abbreviations

CS:

Craniospinal

DL:

Dentate ligament

FMM:

Foramen magnum meningioma

FMMRS:

Foramen Magnum Meningioma Risk Score

HR:

Hazards ratio

KPS:

Karnofsky Performance Scale

GTR:

Gross total resection

SC:

Spinocranial

SOA:

Sub-occipital approach

STR:

Subtotal resection

PLAS:

Posterior-lateral approaches

VA:

Vertebral artery

References

  1. Arnautović KI, Al-Mefty O, Husain M (2000) Ventral foramen magnum meningiomas. J Neurosurg. https://doi.org/10.3171/spi.2000.92.1.0071

    Article  PubMed  Google Scholar 

  2. Castellano F, Ruggiero G (1953) Meningiomas of the posterior fossa. Acta Radiol Suppl 104:1–57

    CAS  PubMed  Google Scholar 

  3. Arnautović KI, Al-Mefty O, Pait TG et al (1997) The suboccipital cavernous sinus. J Neurosurg. https://doi.org/10.3171/jns.1997.86.2.0252

    Article  PubMed  Google Scholar 

  4. David CA, Spetzler RF (1997) Foramen magnum meningiomas. Clin Neurosurg 44:467–89

    CAS  PubMed  Google Scholar 

  5. Miller E, Crockard HA (1987) Transoral transclival removal of anteriorly placed meningiomas at the foramen magnum. Neurosurgery. https://doi.org/10.1227/00006123-198706000-00026

    Article  PubMed  Google Scholar 

  6. Khattar N, Koutourousiou M, Chabot JD et al (2018) endoscopic endonasal and transcranial surgery for microsurgical resection of ventral foramen magnum meningiomas: a preliminary experience. Oper Neurosurg (Hagerstown, Md). https://doi.org/10.1093/ons/opx160

    Article  Google Scholar 

  7. Stevenson GC, Stoney RJ, Perkins RK, Adams JE (1966) A transcervical transclival approach to the ventral surface of the brain stem for removal of a clivus chordoma. J Neurosurg. https://doi.org/10.3171/jns.1966.24.2.0544

    Article  PubMed  Google Scholar 

  8. Guidetti B, Spallone A (1980) Benign extramedullary tumors of the foramen magnum. Surg Neurol. https://doi.org/10.1007/978-3-7091-6954-4_3

    Article  PubMed  Google Scholar 

  9. Salas E, Sekhar LN, Ziyal IM et al (1999) Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients. J Neurosurg. https://doi.org/10.3171/spi.1999.90.2.0206

    Article  PubMed  Google Scholar 

  10. Bruneau M, George B (2008) Foramen magnum meningiomas: Detailed surgical approaches and technical aspects at Lariboisière Hospital and review of the literature. Neurosurg Rev. https://doi.org/10.1007/s10143-007-0097-1

    Article  PubMed  Google Scholar 

  11. Bydon M, Martin Ma T, Xu R et al (2014) Surgical outcomes of craniocervial junction meningiomas: a series of 22 consecutive patients. Clin Neurol Neurosurg. https://doi.org/10.1016/j.clineuro.2013.11.023

    Article  PubMed  Google Scholar 

  12. Koc K, Anik I, Cabuk B, Ceylan S (2008) Fluorescein sodium-guided surgery in glioblastoma multiforme: a prospective evaluation. Br J Neurosurg. https://doi.org/10.1080/02688690701765524

    Article  PubMed  Google Scholar 

  13. Boulton MR, Cusimano MD (2003) Foramen magnum meningiomas: concepts, classifications, and nuances. Neurosurg Focus 14(6):1–8

    Article  Google Scholar 

  14. Lanzino G, Paolini S, Spetzler RF (2005) Far-lateral approach to the craniocervical junction. Neurosurgery. https://doi.org/10.1227/01.NEU.0000176848.05925.80

    Article  PubMed  Google Scholar 

  15. Heros RC (1986) Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions. J Neurosurg. https://doi.org/10.3171/jns.1986.64.4.0559

    Article  PubMed  Google Scholar 

  16. Marin Sanabria EA, Ehara K, Tamaki N et al (2002) Surgical experience with skull base approaches for foramen magnum meningioma. Neurol Med Chir (Tokyo). https://doi.org/10.2176/nmc.42.472

    Article  Google Scholar 

  17. George B, Lot G, Sen C (1995) Anterolateral and posterolateral approaches to the foramen magnum: Technical description and experience from 97 cases. Skull Base Surg 5:9–19

    Article  CAS  Google Scholar 

  18. Couldwell WT (2015) Far lateral transcervical approach to the lower clivus and upper cervical spine. In: Snyderman C, Gardner P (eds) Master techniques in otolaryngology head and neck surgery skull base surgery. Wolters Kluwer, Philadelphia, pp 591–604

    Google Scholar 

  19. Barut N, Kale A, Suslu HT et al (2009) Evaluation of the bony landmarks in transcondylar approach. Br J Neurosurg. https://doi.org/10.1080/02688690902814725

    Article  PubMed  Google Scholar 

  20. Akalan N, Seçkin H, Kiliç C, Özgen T (1994) Benign extramedullary tumors in the foramen magnum region. Clin Neurol Neurosurg. https://doi.org/10.1016/0303-8467(94)90115-5

    Article  PubMed  Google Scholar 

  21. Yang SY, Boniello AJ, Poorman CE et al (2014) A review of the diagnosis and treatment of atlantoaxial dislocations. Glob Spine J. https://doi.org/10.1055/s-0034-1376371

    Article  Google Scholar 

  22. Rhoton J (2000) The far-lateral approach and its transcondylar, supracondylar, and paracondylar extensions. Neurosurgery. https://doi.org/10.1097/00006123-200009001-00020

    Article  PubMed  Google Scholar 

  23. Wright NM, Lauryssen C (1998) Vertebral artery injury in C1–2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. J Neurosurg. https://doi.org/10.3171/jns.1998.88.4.0634

    Article  PubMed  Google Scholar 

  24. Choi D, Crockard HA (2013) Evolution of transoral surgery: three decades of change in patients, pathologies, and indications. Neurosurgery. https://doi.org/10.1227/01.neu.0000430324.24623.10

    Article  PubMed  Google Scholar 

  25. Crockard HA (1985) The transoral approach to the base of the brain and upper cervical cord. Ann R Coll Surg Engl 67(5):321

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Tuite GF, Veres R, Crockard HA, Sell D (1996) Pediatric transoral surgery: indications, complications, and long-term outcome. J Neurosurg. https://doi.org/10.3171/jns.1996.84.4.0573

    Article  PubMed  Google Scholar 

  27. Magill ST, Shahin MN, Lucas CHG et al (2018) Surgical Outcomes, Complications, and management strategies for foramen magnum meningiomas. J Neurol Surg Part B Skull Base. https://doi.org/10.1055/s-0038-1654702

    Article  Google Scholar 

  28. Mehta GU, Zenonos G, Patibandla MR et al (2018) Outcomes of stereotactic radiosurgery for foramen magnum meningiomas: an international multicenter study. J Neurosurg. https://doi.org/10.3171/2017.3.JNS163008

    Article  PubMed  Google Scholar 

  29. Margalit NS, Lesser JB, Singer M, Sen C (2005) Lateral approach to anterolateral tumors at the foramen magnum: factors determining surgical procedure. Neurosurgery. https://doi.org/10.1227/01.NEU.0000156796.28536.6D

    Article  PubMed  Google Scholar 

  30. Talacchi A, Biroli A, Soda C et al (2012) Surgical management of ventral and ventrolateral foramen magnum meningiomas: report on a 64-case series and review of the literature. Neurosurg Rev 35(3):359–68

    Article  Google Scholar 

  31. Li D, Wu Z, Ren C et al (2017) Foramen magnum meningiomas: surgical results and risks predicting poor outcomes based on a modified classification. J Neurosurg. https://doi.org/10.3171/2016.2.JNS152873

    Article  PubMed  Google Scholar 

  32. George B, Lot G, Boissonnet H (1997) Meningioma of the foramen magnum: a series of 40 cases. Surg Neurol. https://doi.org/10.1016/S0090-3019(96)00204-2

    Article  PubMed  Google Scholar 

  33. Samii M, Klekamp J, Carvalho G (1996) Surgical results for meningiomas of the craniocervical junction. Neurosurgery. https://doi.org/10.1097/00006123-199612000-00003

    Article  PubMed  Google Scholar 

  34. Legnani FG, Saladino A, Casali C et al (2013) Craniotomy vs. craniectomy for posterior fossa tumors: a prospective study to evaluate complications after surgery. Acta Neurochir (Wien) 155:2281–2286. https://doi.org/10.1007/s00701-013-1882-y

    Article  Google Scholar 

  35. Legninda Sop FY, D’Ercole M, Izzo A et al (2021) The impact of neuronavigation on the surgical outcome of microvascular decompression for trigeminal neuralgia. World Neurosurg 149:80–85. https://doi.org/10.1016/j.wneu.2021.02.063

    Article  PubMed  Google Scholar 

  36. Lau T, Reintjes S, Olivera R et al (2015) C-shaped incision for far-lateral suboccipital approach: anatomical study and clinical correlation. J Neurol Surg Part B Skull Base 76:117–121. https://doi.org/10.1055/s-0034-1390396

    Article  Google Scholar 

  37. Felbaum DR, Mueller K, Anaizi A et al (2016) Preservation of the myofascial cuff during posterior fossa surgery to reduce the rate of pseudomeningocele formation and cerebrospinal fluid leak: a technical note. Cureus. https://doi.org/10.7759/cureus.946

    Article  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, 94305, USA

    Nida Fatima, Steven D. Chang & Antonio Meola

  2. Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA

    Nida Fatima, John H. Shin & William T. Curry

Authors
  1. Nida Fatima
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John H. Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William T. Curry
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steven D. Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antonio Meola
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio Meola.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

IRB Approved Stanford Health Care and Massachusetts General Hospital.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

11060_2021_3773_MOESM1_ESM.jpg

Supplementary file1 Predicted probability of tumor resection with complications on the basis of Foramen Magnum Meningioma Risk Score (FMMRS) class. (a) The AUC curve was 0.81 (95% CI 0.61–0.98) in the internal validation cohort. (b) The AUC of the scoring system was 0.86 (95% CI 0.65–0.97) in the external validation cohort. (JPG 52 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fatima, N., Shin, J.H., Curry, W.T. et al. Microsurgical resection of foramen magnum meningioma: multi-institutional retrospective case series and proposed surgical risk scoring system. J Neurooncol 153, 331–342 (2021). https://doi.org/10.1007/s11060-021-03773-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-021-03773-z

Keywords

Search

Navigation