CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2019; 80(S 04): S360-S362
DOI: 10.1055/s-0039-1695063
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Microsurgical Gross Total Resection of Foramen Magnum Meningioma via Far Lateral Approach

Sima Sayyahmelli
1  Department of Neurological Surgery, University of Wisconsin Medical School, Madison, Wisconsin, United States
,
Mustafa K. Başkaya
1  Department of Neurological Surgery, University of Wisconsin Medical School, Madison, Wisconsin, United States
› Author Affiliations
Disclosure of Funding None.
Further Information

Publication History

15 February 2019

09 July 2019

Publication Date:
15 October 2019 (online)

Abstract

Foramen magnum meningiomas are one of the most challenging tumors for skull base neurosurgeons due to their proximity to critical neurovascular structures. The far-lateral approach demonstrated here facilitates access to lesions involving the anterior portion of the foramen magnum.

In this video, we present a 62-year-old woman with hand numbness and weakness. The patient had significant difficulty in fine motor movements of both hands. In the neurological examination, she had a significant right-hand intrinsic muscle weakness and mild quadriparesis.

Magnetic resonance imaging (MRI) showed a dural-based homogeneously enhancing extra-axial mass in the anterior foramen magnum with a significant mass effect on the brain stem and the upper cervical cord. The decision was made to proceed with a far lateral transcondylar skull base approach including partial C1 laminectomy.

The surgery and postoperative course were uneventful. The postoperative MRI showed gross total resection of the mass. The histopathology indicated a WHO (World health Organization) grade-I meningioma. The patient's postoperative course was uneventful. She improved to normal neurological function within several weeks and continues to do well without recurrence at 20 months' follow-up.

In this video, we demonstrated important steps for the microsurgical resection of these challenging lesions.

The link to the video can be found at: https://youtu.be/_nuX2Y7YU9w.