Foramen Magnum Meningioma Presenting with Cough Syncope (Case Report and Review of the Literature)

Abstract

Foramen magnum meningiomas cause different symptoms based on the size and the location of the tumor. They often present with involvement of the long tracts and of the lower cranial nerves. Ataxia and occipitocervical headache are other common symptoms. In the present study, we report a case of foramen magnum meningioma presenting with cough syncope. A mass lesion located anterolateral to the foramen magnum was detected in a 38-year-old man during a magnetic resonance imaging (MRI) exam; the lesion extended from the inferior clivus to the level of the C2 vertebra. The neural axis has pushed towards posterior and contralateral side by the mass. We think that syncope occurred due to the encasement of the vertebral arteries by the tumor in addition to the compression of the neural axis. The posterolateral approach without condylar resection provides a safe surgical plane for total excision of these tumors. In our case, the tumor was totally removed and the syncope episodes were resolved.

Resumo

Os meningiomas do forame magno causam sintomas diferentes com base no tamanho e na localização do tumor. Eles frequentemente apresentam envolvimento dos longos tratos e dos nervos cranianos inferiores. Ataxia e cefaleia occipitocervical são outros sintomas comuns. No presente estudo, relatamos um caso de meningioma do forame magno que apresentava síncope por tosse. Uma lesão em massa, localizada anterolateralmente ao forame magno, foi detectada em um homem de 38 anos durante um exame de ressonância magnética (RM). A lesão se estendia do clivus inferior ao nível da vértebra C2. O eixo neural foi empurrado para o lado posterior e contralateral pela massa. Pensamos que a síncope ocorreu devido ao encapsulamento das artérias vertebrais pelo tumor, além da compressão do eixo neural. A abordagem posterolateral sem ressecção condilar oferece um plano cirúrgico seguro para a excisão total desses tumores. No nosso caso, o tumor foi totalmente removido e os episódios de síncope foram resolvidos.

Keywords

far lateral approach - foramen magnum meningioma - syncope

Palavras-chave

abordagem lateral - meningioma do forame magno - sincope

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