Far Lateral Retrocondylar Approach in Management of Anterior and Anterolateral Foramen Magnum Meningioma.Local Experience at Sohag University

Background: Foramen Magnum Meningiomas (FMMs) represent a neurosurgical challenge because they grow in close contact with osteoarticular, nervous, and vascular structures that cannot be sacrificed or retracted. Objective: To evaluate our strategy and results in six patients with FMMs and analyze factors affecting the decision-making process, resection, and outcome. Patients and Methods: Six patients with foramen magnum meningioma operated at Sohag University hospital in the period between 2007 and 2012 with an age ranged from 25-65 years and the sex distribution showed four females and two males. All cases were examined clinically preoperative for the neurological status. Cranial MRI was done for all cases preoperatively. One stage operation was done for complete excision of the meningioma using a posterolateral retrocondylar approach in the three quarter position. Postoperative assessment for the neurological function and imaging study was done. Results: After surgical excision of the meningioma assessment of the neurological state was done and all patients were active and independent. One patient developed exaggerated and permanent ipsilateral lower cranial nerve palsy. All patients improved in their motor power. Paresthesia and sensory deficits resolved completely in four patients (60%). Respiratory dysfunction in one patient resolved completely. No cases showed recurrence during the period of follow up. Conclusion: Anterior and anterolateral FM meningiomas that displace the medulla/spinal cord can be safely and completely resected via a posterolateral suboccipital retrocondylar approach. A tumor remnant should be left on critical neurovascular structures in cases with poor arachnoid dissection planes.