DOI: https://doi.org/10.25305/unj.150786

Experience of diagnostics and treatment of 34 cases of foramen magnum meningiomas

Yuriy G. Shanko, Arnold F. Smeyanovich, Vladimir V. Bulgak

Abstract


Objective: optimization microsurgical methods of meningioma resection in foramen occipitalis magnum.

Materials and methods. Our study includes 34 observations, patients aged 18 to 75 years (median age 52.8 years) in the period from 1991 to 2016. There were 7 men, 27 women (ratio M : F — 1 : 3.9). This amounted to about 1.6% of the total number of patients with symptomatic meningiomas. To assess the extent of surgical treatment, we used the gradation system of D. Simpson.

Results. Total tumor resection was performed in 24 (70.6%) cases, subtotal — in 6 (17.6%) cases, partial — in 4 (11.8%) patients. There was no postoperative mortality. Tumor recurrence was not observed during the whole observation period. Tumor resection was performed in two stages, in one case, because of decrease in blood pressure to 60 mm Hg and bradycardia during the first intervention, probably due to brainstem dislocation. The remaining tumor portion was completely removed after 5 months.

In the early postoperative period, lower cranial nerves and C1-C2 rootlets dysfunctions were registered in 19 (55.9%) patients, and 13 (38.2%) patients had mild or moderate pyramidal disorders. Cerebellar ataxia was revealed in 22 (64.7%) observations. Clinically significant pneumocephalus was diagnosed in 3 (8.8%) cases, which required air extraction (patients were operated in the sitting position). There were no hemorrhagic complications in any case.

Postoperative radiosurgery (gamma-knife) was carried out in 1 (2.9%) case (after subtotal tumor removal), radiotherapy — in 4 (11.8%) cases after partial and subtotal fossa magnum meningioma resection.

Functional outcomes were initially estimated according to the Karnofsky performance status scale in the period from 6 to 14 months after the surgery. Twenty-three patients (67.7%) experienced 90–100% (no disability or vital activity), 8 (23.5%) patients had 70–80% (mild disability and vital dysfunction), 3 (8.8%) patients experienced 50–60% (moderate disability and life-support needed), whose tumor was partially removed. There were no gross neurological disorders, which significantly restricted the ability to work and live.

All patients were or continue to be monitored according to clinical protocols, all of them were recommended to undergo a control MRI at least once a year. Catamnesis was up to 19 years. There were no repeated complaints about recurrence or continued fossa magnum meningioma growth in either case, even after subtotal or partial tumor removal.

Conclusions. The suboccipital lateral approach with laminectomy to the level of the lower tumor pole was sufficient enough to provide adequate microsurgical craniovertebral meningioma resection without resection of the atlantooccipital articulation. The approach to neoplasm matrix was performed after tumor partial resection without brain stem traction. The use of intraoperative neuromonitoring provided the control of brain stem functions at all stages of tumor resection and vertebral artery isolation.


Keywords


craniovertebral area; foramen (occipitalis) magnum; meningiomas; microsurgery; surgical outcomes

References


1. Ostrom QT, de Blank PM, Kruchko C, Petersen CM, Liao P, Finlay JL, Stearns DS, Wolff JE, Wolinsky Y, Letterio JJ, Barnholtz-Sloan JS. Alex's Lemonade Stand Foundation Infant and Childhood Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2007-2011. Neuro Oncol. 2015 Jan;16 Suppl 10:x1-x36. [CrossRef] [PubMed] [PubMed Central]

2. Davis FG, McCarthy BJ, Berger MS. Centralized databases available for describing primary brain tumor incidence, survival, and treatment: Central Brain Tumor Registry of the United States; Surveillance, Epidemiology, and End Results; and National Cancer Data Base. Neuro Oncol. 1999 Jul;1(3):205-11. [CrossRef] [PubMed] [PubMed Central]

3. Kleihues P, Cavenee WK. Pathology and Genetics of the Tumours of the Nervous System. Lyon: IARC Press, 2000.

4. Tigliev GS, Olyushin VE, Kondratiev AN. Intracranial meningiomas. St. Petersburg: RNKHI im. prof. A.L. Polenova; 2001. Russian.

5. George B, Lot G. Foramen Magnum Meningiomas: A Review from Personal Experience of 37 Cases and from a Cooperative Study of 106 Cases. Neurosurgery Quarterly. Ovid Technologies (Wolters Kluwer Health); 1995 Sep;5(3):149–67. [CrossRef]

6. Putsillo MV, Vinokurov AG, Belov AI, Konovalov AN (ed.). Atlas. Neurosurgical anatomy. Volume 1. Moscow: Antidor; 2002. Russian.

7. Boulton MR, Cusimano MD. Foramen magnum meningiomas: concepts, classifications, and nuances. Neurosurg Focus. 2003 Jun 15;14(6):e10. [CrossRef] [PubMed]

8. Bruneau M, George B. Classification system of foramen magnum meningiomas. J Craniovertebr Junction Spine. 2010 Jan;1(1):10-7. [CrossRef] [PubMed] [PubMed Central]

9. Yaşargil MG, Mortara RW, Curcic M. Meningiomas of Basal Posterior Cranial Fossa. Advances and Technical Standards in Neurosurgery. Springer Vienna; 1980;3–115. [CrossRef]

10. Miller E, Crockard HA. Transoral transclival removal of anteriorly placed meningiomas at the foramen magnum. Neurosurgery. 1987 Jun;20(6):966-8. [CrossRef] [PubMed]

11. Arnautović KI, Al-Mefty O, Husain M. Ventral foramen magnum meninigiomas. J Neurosurg. 2000 Jan;92(1 Suppl):71-80. [CrossRef] [PubMed]

12. Bruneau M, George B. Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisière Hospital and review of the literature. Neurosurg Rev. 2008 Jan;31(1):19-32; discussion 32-3. [CrossRef] [PubMed] [PubMed Central]

13. Koos WT, Spetzler RF, Pendl G, Perneczky A, Lang J. Color Atlas of Microneurosurgery. Stuttgart: Thieme Verlag; 1985.

14. Perneczky A. The Posterolateral Approach to the Foramen Magnum. Surgery in and around the Brain Stem and the Third Ventricle. Springer Berlin Heidelberg; 1986;460–6. [CrossRef]

15. Bertalanffy H, Gilsbach JM, Mayfrank L, Klein HM, Kawase T, Seeger W. Microsurgical management of ventral and ventrolateral foramen magnum meningiomas. Acta Neurochir Suppl. 1996;65:82-5. [CrossRef] [PubMed]

16. George B, Lot G, Boissonnet H. Meningioma of the foramen magnum: a series of 40 cases. Surg Neurol. 1997 Apr;47(4):371-9. [CrossRef] [PubMed]

17. Sen CN, Sekhar LN. An extreme lateral approach to intradural lesions of the cervical spine and foramen magnum. Neurosurgery. 1990 Aug;27(2):197-204. [CrossRef] [PubMed]

18. Kratimenos GP, Crockard HA. The far lateral approach for ventrally placed foramen magnum and upper cervical spine tumours. Br J Neurosurg. 1993;7(2):129-40. [CrossRef] [PubMed]

19. Crockard HA, Sen CN. The transoral approach for the management of intradural lesions at the craniovertebral junction: review of 7 cases. Neurosurgery. 1991 Jan;28(1):88-97; discussion 97-8. [CrossRef] [PubMed]

20. Pamir MN, Özduman K. Foramen Magnum Meningiomas. Meningiomas. Elsevier; 2010;543–57. [CrossRef]

21. Shanko Y, Smeyanovich A, Bulgak V, Rodzich A. Intraoperative monitoring of foramen occipitalis magnum meningiomas surgery significantly improves the preservation of neurological functions. Activitas Nervosa Superior Rediviva. 2015;57(3):72–76. http://www.rediviva.sav.sk/57i3/72.pdf

22. Pirotte B, David P, Noterman J, Brotchi J. Lower clivus and foramen magnum anterolateral meningiomas: surgical strategy. Neurol Res. 1998 Oct;20(7):577-84. [CrossRef] [PubMed]

23. Sharma BS, Gupta SK, Khosla VK, Mathuriya SN, Khandelwal N, Pathak A, Tewari MK, Kak VK. Midline and far lateral approaches to foramen magnum lesions. Neurol India. 1999 Dec;47(4):268-71. [PubMed]

24. Kandenwein JA, Richter HP, Antoniadis G. Foramen magnum meningiomas--experience with the posterior suboccipital approach. Br J Neurosurg. 2009 Feb;23(1):33-9. [CrossRef] [PubMed]

25. Kano T, Kawase T, Horiguchi T, Yoshida K. Meningiomas of the ventral foramen magnum and lower clivus: factors influencing surgical morbidity, the extent of tumour resection, and tumour recurrence. Acta Neurochir (Wien). 2010 Jan;152(1):79-86; discussion 86. [CrossRef] [PubMed]

26. Borba LA, de Oliveira JG, Giudicissi-Filho M, Colli BO. Surgical management of foramen magnum meningiomas. Neurosurg Rev. 2009 Jan;32(1):49-58; discussion 59-60. [CrossRef] [PubMed]

27. Nair SN, Vikas V, Gopalakrishnan CV, Menon G. Surgical Management of Foramen Magnum Meningiomas. Neurosurgery Quarterly. Ovid Technologies (Wolters Kluwer Health); 2012 Nov;22(4):220–5. [CrossRef]

28. Bassiouni H, Ntoukas V, Asgari S, Sandalcioglu EI, Stolke D, Seifert V. Foramen magnum meningiomas: clinical outcome after microsurgical resection via a posterolateral suboccipital retrocondylar approach. Neurosurgery. 2006 Dec;59(6):1177-85; discussion 1185-7. [CrossRef] [PubMed]

29. Bydon M, Ma TM, Xu R, Weingart J, Olivi A, Gokaslan ZL, Tamargo RJ, Brem H, Bydon A. Surgical outcomes of craniocervial junction meningiomas: a series of 22 consecutive patients. Clin Neurol Neurosurg. 2014 Feb;117:71-9. [CrossRef] [PubMed] [PubMed Central]

30. Wu Z, Hao S, Zhang J, Zhang L, Jia G, Tang J, Xiao X, Wang L, Wang Z. Foramen magnum meningiomas: experiences in 114 patients at a single institute over 15 years. Surg Neurol. 2009 Oct;72(4):376-82; discussion 382. [CrossRef] [PubMed]

31. Tanyashin SV, Kondrakhov SV, Shimanskiy VN. Metodiki i rezul'taty khirurgicheskogo lecheniya meningiom oblasti bol'shogo zatylochnogo otverstiya. Rossiyskiy neyrokhirurgicheskiy zhurnal imeni professora A.L. Polenova. 2016;8(1):26-35. Russian.

32. Bogorodinskiy DK, Skoromets A.A. Craniovertebral pathology. Moscow: GEOTAR-Media; 2008. Russian.

33. Stein BM, Leeds NE, Taveras JM, Pool JL. Meningiomas of the foramen magnum. J Neurosurg. 1963 Sep;20:740-51. [CrossRef] [PubMed]

34. Goel A, Desai K, Muzumdar D. Surgery on anterior foramen magnum meningiomas using a conventional posterior suboccipital approach: a report on an experience with 17 cases. Neurosurgery. 2001 Jul;49(1):102-6; discussion 106-7. [CrossRef] [PubMed]

35. Rhoton AL Jr. The far-lateral approach and its transcondylar, supracondylar, and paracondylar extensions. Neurosurgery. 2000 Sep;47(3 Suppl):S195-209. [PubMed]

36. Sohn S, Chung CK. Conventional Posterior Approach without Far Lateral Approach for Ventral Foramen Magnum Meningiomas. J Korean Neurosurg Soc. 2013 Nov;54(5):373-8. [CrossRef] [PubMed] [PubMed Central]

37. Marin Sanabria EA, Ehara K, Tamaki N. Surgical experience with skull base approaches for foramen magnum meningioma. Neurol Med Chir (Tokyo). 2002 Nov;42(11):472-8; discussion 479-80. [CrossRef] [PubMed]

38. Salas E, Sekhar LN, Ziyal IM, Caputy AJ, Wright DC. Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients. J Neurosurg. 1999 Apr;90(2 Suppl):206-19. [CrossRef] [PubMed]


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