CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2019; 80(S 04): S363-S364
DOI: 10.1055/s-0039-1695701
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Foramen Magnum Meningioma: Far Lateral Approach

Ciro Vasquez
1  Department of Neurosurgery, University of Colorado, Aurora, Colorado, United States
,
Alexander Yang
1  Department of Neurosurgery, University of Colorado, Aurora, Colorado, United States
,
A. Samy Youssef
1  Department of Neurosurgery, University of Colorado, Aurora, Colorado, United States
› Author Affiliations
Further Information

Address for correspondence

A. Samy Youssef, MD PhD
Department of Neurosurgery, University of Colorado
Mail Stop C307, 12631 East 17th Avenue, Aurora, CO 80045
United States   

Publication History

17 February 2019

08 July 2019

Publication Date:
15 October 2019 (online)

 

Abstract

We present a case of a foramen magnum meningioma in a 42-year-old female who presented with headaches for 2 years, associated with decreased sensation and overall feeling of “heaviness” of the right arm. The tumor posed significant mass effect on the brainstem, and given the location of the tumor in the anterolateral region of the foramen magnum, a right far lateral approach was chosen. The approach incorporates the interfascial dissection technique to safely expose and preserve the vertebral artery in the suboccipital triangle. After drilling the posteromedial portion of the occipital condyle and opening the dura, the tumor can be entirely exposed with minimal retraction on the cerebellum. The working space offered by the far lateral approach allows careful dissection at the lateral craniocervical junction, and preservation of the V4 segment of the vertebral artery and the lower cranial nerves. Simpson's grade-2 resection was achieved with coagulation of the dural base around the vertebral artery. The postoperative course was unremarkable for any neurological deficits. At the 2-year follow-up, imaging identified no recurrence of tumor and the patient remains asymptomatic.

The link to the video can be found at: https://youtu.be/IMN1O7vO5B0.


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Zoom Image
Fig. 1 Preoperative MRI demonstrating vertebral artery V4 segment encased in tumor. MRI, magnetic resonance imaging.
Zoom Image
Fig. 2 Intraoperative identification and isolation of the vertebral artery V4 segment.

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Quality:

Publication Comments

The authors present a trans condylar far lateral approach for the removal of a foramen magnum meningioma which is encasing the left vertebral artery. I would like to commend the authors for a great postoperative result which has shown in the follow up no recurrence. The thorough analysis of the transcondylar approach vs retro condylar is educational for the formation of skull base surgeons to understand the advantages of the approach.

Diego Mendez Rosito, MD

CMN 20 de Noviembre

Mexico City, Mexico


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Conflict of Interest

None declared.

Address for correspondence

A. Samy Youssef, MD PhD
Department of Neurosurgery, University of Colorado
Mail Stop C307, 12631 East 17th Avenue, Aurora, CO 80045
United States   

Zoom Image
Fig. 1 Preoperative MRI demonstrating vertebral artery V4 segment encased in tumor. MRI, magnetic resonance imaging.
Zoom Image
Fig. 2 Intraoperative identification and isolation of the vertebral artery V4 segment.