CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2020; 39(02): 061-067
DOI: 10.1055/s-0039-1695015
Original Article | Artigo Original
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Tailored Surgical Approaches for Foramem Magnum Tumors

Abordagens personalizadas aos tumores do forame magno
1  Department of Neurosurgery, Centro de Neurocirurgia das Américas, Rio de Janeiro, Rio de Janeiro, Brazil
,
Celestino Esteves Pereira
2  Department of Neurosurgery, Public Servants Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
,
Leonardo C. Weling
3  Department of Neurosurgery, University of Ponta Grossa, Paraná, PR, Brazil
,
Mariangela Gonçalves
4  Department of Neurosurgery, Copa D'or Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
› Author Affiliations
Further Information

Publication History

23 October 2018

12 June 2019

Publication Date:
16 October 2019 (online)

  

Abstract

Objective To describe our surgical techniques, analyze their safety and their postoperative outcomes for foramen magnum tumors (FMTs).

Methods From 1986 to 2014, 34 patients with FMTs underwent surgeries using either the lateral suboccipital approach, standard midline suboccipital craniotomy, or the far lateral approach, depending on the anatomic location of the lesions.

Results In the present series, there were 22 (64.7%) female and 12 (35.2%) male patients. The age of the patients ranged from 12 to 63 years old. We observed 1 operative mortality (2.9%). A total of 28 patients (82.3%) achieved a score of 4 or 5 in the Glasgow Outcome Scale (GOS). Gross total resection (GTR) was obtained in 22 (64.7%) patients. After the surgery, 9 (26%) patients developed lower cranial nerve dysfunction (LCNd) weakness. The follow-up varied from 1 to 24 years (mean: 13.2 years).

Conclusion The majority of tumors located in the FM can be safely and efficiently removed using either the lateral sub occipital approach, standard middle line sub occipital craniotomy, or the far lateral approach, depending on the anatomic location of the lesions.

Resumo

Objetivo Descrever as nossas técnicas cirúrgicas, analisar sua segurança, relatar e discutir os resultados para tumores localizados no foramen magnum (FM).

Método Este um estudo retrospectivo de 34 pacientes com tumores localizados no FM que foram submetidos a craniectomia suboccipital lateral, ou a craniectomia clássica suboccipital, ou ainda ao acesso extremo lateral, entre os anos de 1986 a 2014.

Resultados Este grupo de pacientes foi composto por 12 homens (35.2%) e 22 (64.7%) mulheres, cuja idade variou de 12 a 63 anos. A remoção total da lesão ocorreu em 22 (64,7%) indivíduos. A mortalidade cirúrgica foi observada em apenas 1 paciente (2,9%). Um total de 28 (82.3%) pacientes alcançaram 4 ou 5 pontos na Escala de Resultados de Glasgow. O acompanhamento médio foi de 13,2 anos.

Conclusão A maioria dos tumores localizados no FM podem ser removidos adequadamente empregando-se ou a craniectomia suboccipital lateral retrocondilar, o acesso mediano clássico ou, em raros casos, o acesso extremo lateral.