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J Neurol Surg B Skull Base 2021; 82(06): 682-688
DOI: 10.1055/s-0040-1715559
Original Article

Ovoid Foramen Magnum Shape is Associated with Increased Complications and Decreased Extent of Resection for Anterolateral Foramen Magnum Meningiomas

Hakan Kina
1   Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States
,
Ufuk Erginoglu
1   Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States
,
Sahin Hanalioglu
1   Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States
,
Burak Ozaydin
1   Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States
,
Mustafa K. Baskaya
1   Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States
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Abstract

Background Antero-laterally located meningiomas of the foramen magnum (FM) pose significant surgical resection challenges. The effect of FM shape on surgical resection of FM meningiomas has not been previously studied. The present study investigates how FM shape effects the extent of tumor resection and complication rates in antero-lateral FM meningiomas.

Materials and Methods This retrospective study included 16 consecutive patients with antero-lateral FM meningiomas operated on by a single surgeon. FMs were classified as ovoid (n = 8) and nonovoid (n = 8) using radiographic evaluation.

Results Sixteen patients were examined: seven males and nine females (mean age of 58.5, and range of 29 to 81 years). Gross total resection was achieved in 81% of patients, with tumor encased vertebral arteries in 44%. Patient characteristics were similar including age, sex, preoperative tumor volume, relationship of vertebral artery with tumor, preoperative Karnofsky performance score (KPS), symptom duration, and presence of lower cranial nerve symptoms. The ovoid FM group had lower volumetric extents of resection without statistical significance (93 ± 10 vs. 100 ± 0%, p = 0.069), more intraoperative blood loss (319 ± 75 vs. 219 ± 75 mL, p = 0.019), more complications per patient (1.9 ± 1.8 vs. 0.3 ± 0.4, p = 0.039), and poorer postoperative KPS (80 ± 21 vs. 96 ± 5, p = 0.007). Hypoglossal nerve palsy was more frequent in the ovoid FM group (38 vs. 13%).

Conclusion This is the first study demonstrating that ovoid FMs may pose surgical challenges, poorer operative outcomes, and lower rates of extent of resection. Preoperative radiological investigation including morphometric FM measurement to determine if FMs are ovoid or nonovoid can improve surgical planning and complication avoidance.

Keywords

foramen magnum - foramen magnum shape - meningioma - anterolateral - far lateral approach - complication - lower cranial nerves - extent of resection

Authors' Contributions

The first two authors contributed equally to this work.




Publication History

Received: 09 December 2019

Accepted: 11 June 2020

Article published online:
05 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Aras Y, Kiris T. Foramen magnum meningiomlari. Türk Nöroşirürji Dergisi 2011; 21 (02) 158-161
    PubMedGoogle Scholar
  • 2 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; 59 (06) 1177-1185 , discussion 1185–1187
    CrossrefPubMedGoogle Scholar
  • 3 Bertalanffy H, Seeger W. The dorsolateral, suboccipital, transcondylar approach to the lower clivus and anterior portion of the craniocervical junction. Neurosurgery 1991; 29 (06) 815-821
    CrossrefPubMedGoogle Scholar
  • 4 de Oliveira E, Rhoton Jr AL, Peace D. Microsurgical anatomy of the region of the foramen magnum. Surg Neurol 1985; 24 (03) 293-352
    CrossrefPubMedGoogle Scholar
  • 5 George B, Dematons C, Cophignon J. Lateral approach to the anterior portion of the foramen magnum. Application to surgical removal of 14 benign tumors: technical note. Surg Neurol 1988; 29 (06) 484-490
    CrossrefPubMedGoogle Scholar
  • 6 Heros RC. Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions. J Neurosurg 1986; 64 (04) 559-562
    CrossrefPubMedGoogle Scholar
  • 7 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; 49 (01) 102-106 , discussion 106–107
    PubMedGoogle Scholar
  • 8 Arnautović KI, Al-Mefty O, Husain M. Ventral foramen magnum meninigiomas. J Neurosurg 2000; 92 (01) 71-80
    CrossrefPubMedGoogle Scholar
  • 9 David CA, Spetzler RF. Foramen magnum meningiomas. Clin Neurosurg 1997; 44: 467-489
    PubMedGoogle Scholar
  • 10 George B, Lot G, Boissonnet H. Meningioma of the foramen magnum: a series of 40 cases. Surg Neurol 1997; 47 (04) 371-379
    CrossrefPubMedGoogle Scholar
  • 11 Samii M, Klekamp J, Carvalho G. Surgical results for meningiomas of the craniocervical junction. Neurosurgery 1996; 39 (06) 1086-1094 , discussion 1094–1095
    CrossrefPubMedGoogle Scholar
  • 12 Magill ST, Shahin MN, Lucas CG. et al. Surgical outcomes, complications, and management strategies for foramen magnum meningiomas. J Neurol Surg B Skull Base 2019; 80 (01) 1-9
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Boulton MR, Cusimano MD. Foramen magnum meningiomas: concepts, classifications, and nuances. Neurosurg Focus 2003; 14 (06) e10
    CrossrefPubMedGoogle Scholar
  • 14 Bruneau M, George B. Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisière Hospital and review of the literature. Neurosurg Rev 2008; 31 (01) 19-32 , discussion 32–33
    CrossrefPubMedGoogle Scholar
  • 15 Bruneau M, George B. Classification system of foramen magnum meningiomas. J Craniovertebr Junction Spine 2010; 1 (01) 10-17
    CrossrefPubMedGoogle Scholar
  • 16 Li D, Wu Z, Ren C. et al. Foramen magnum meningiomas: surgical results and risks predicting poor outcomes based on a modified classification. J Neurosurg 2017; 126 (03) 661-676
    CrossrefPubMedGoogle Scholar
  • 17 Degno S, Abrha M, Asmare Y, Muche A. Anatomical variation in morphometry and morphology of the foramen magnum and occipital condyle in dried adult skulls. J Craniofac Surg 2019; 30 (01) 256-259
    CrossrefPubMedGoogle Scholar
  • 18 Burdan F, Szumiło J, Walocha J. et al. Morphology of the foramen magnum in young Eastern European adults. Folia Morphol (Warsz) 2012; 71 (04) 205-216
    PubMedGoogle Scholar
  • 19 Avci E, Dagtekin A, Ozturk AH. et al. Anatomical variations of the foramen magnum, occipital condyle and jugular tubercle. Turk Neurosurg 2011; 21 (02) 181-190
    PubMedGoogle Scholar
  • 20 Komotar RJ, Zacharia BE, McGovern RA, Sisti MB, Bruce JN, D'Ambrosio AL. Approaches to anterior and anterolateral foramen magnum lesions: a critical review. J Craniovertebr Junction Spine 2010; 1 (02) 86-99
    CrossrefPubMedGoogle Scholar
  • 21 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; 90 (02) 206-219
    CrossrefPubMedGoogle Scholar
  • 22 Sen CN, Sekhar LN. An extreme lateral approach to intradural lesions of the cervical spine and foramen magnum. Neurosurgery 1990; 27 (02) 197-204
    CrossrefPubMedGoogle Scholar
  • 23 Spetzler R. The far-lateral approach to the inferior clivus and the upper cervical region. BNI Q 1990; 6: 35-38
    PubMedGoogle Scholar
  • 24 Colli BO, Carlotti-Junior CG, Assirati-Junior JA, Borba LAB, Coelho-Junior VdeP, Neder L. Foramen magnum meningiomas: surgical treatment in a single public institution in a developing country. Arq Neuropsiquiatr 2014; 72 (07) 528-537
    CrossrefPubMedGoogle Scholar
  • 25 Flores BC, Boudreaux BP, Klinger DR, Mickey BE, Barnett SL. The far-lateral approach for foramen magnum meningiomas. Neurosurg Focus 2013; 35 (06) E12
    CrossrefPubMedGoogle Scholar
  • 26 Pirotte BJ, Brotchi J, DeWitte O. Management of anterolateral foramen magnum meningiomas: surgical vs. conservative decision making. Neurosurgery 2010;67(03), Suppl Operative ):ons58–ons70, discussion ons70
    PubMedGoogle Scholar
  • 27 George B, Lot G, Velut S, Gelbert F, Mourier KL. [French language Society of Neurosurgery. 44th Annual Congress. Brussels, 8-12 June 1993. Tumors of the foramen magnum]. Neurochirurgie 1993; 39 (Suppl. 01) 1-89
    PubMedGoogle Scholar
  • 28 Sekhar LN, Wright DC, Richardson R, Monacci W. Petroclival and foramen magnum meningiomas: surgical approaches and pitfalls. J Neurooncol 1996; 29 (03) 249-259
    CrossrefPubMedGoogle Scholar
  • 29 Wu Z, Hao S, Zhang J. et al. Foramen magnum meningiomas: experiences in 114 patients at a single institute over 15 years. Surg Neurol 2009; 72 (04) 376-382 , discussion 382
    CrossrefPubMedGoogle Scholar
  • 30 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; 152 (01) 79-86 , discussion 86
    CrossrefPubMedGoogle Scholar
  • 31 Nanda A, Vincent DA, Vannemreddy PS, Baskaya MK, Chanda A. Far-lateral approach to intradural lesions of the foramen magnum without resection of the occipital condyle. J Neurosurg 2002; 96 (02) 302-309
    CrossrefPubMedGoogle Scholar
  • 32 Pamir MN, Kiliç T, Ozduman K, Türe U. Experience of a single institution treating foramen magnum meningiomas. J Clin Neurosci 2004; 11 (08) 863-867
    CrossrefPubMedGoogle Scholar
  • 33 Perneczky A. The posterolateral approach to the foramen magnum. . In: Surgery in and Around the Brain Stem and the Third Ventricle. Springer; 1986: 460-466
    Google Scholar
  • 34 Talacchi A, Biroli A, Soda C, Masotto B, Bricolo A. Surgical management of ventral and ventrolateral foramen magnum meningiomas: report on a 64-case series and review of the literature. Neurosurg Rev 2012; 35 (03) 359-367 , discussion 367–368
    CrossrefPubMedGoogle Scholar