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Conventional Posterior Approach without Far Lateral Approach for Ventral Foramen Magnum Meningiomas
1Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea. ; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea. ; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
Objective:
We present our experience of conventional posterior approach without fat lateral approach for ventral foramen magnum (FM) meningioma (FM meningioma) and tried to evaluate the approach is applicable to ventral FM meningioma.
Methods:
From January 1999 to March 2011, 11 patients with a ventral FM meningioma underwent a conventional posterior approach without further extension of lateral bony window. The tumor was removed through a working space between the dura and arachnoid membrane at the cervicomedullary junction with minimal retraction of medulla, spinal cord or cerebellum. Care should be taken not to violate arachnoid membrane.
Results:
Preoperatively, six patients were of Nurick grade 1, three were of grade 2, and two were of grade 3. Median follow-up period was 55 months (range, 20-163 months). The extent of resection was Simpson grade I in one case and Simpson grade II in remaining 10 cases. Clinical symptoms improved in eight patients and stable in three patients. There were no recurrences during the follow-up period. Postoperative morbidities included one pseudomeningocele and one transient dysphagia with dysarthria.
Conclusion:
Ventral FM meningiomas can be removed gross totally using a posterior approach without fat lateral approach. The arachnoid membrane can then be exploited as an anatomical barrier. However, this approach should be taken with a thorough understanding of its anatomical limitation.
Insights
A posterior approach effectively removes ventral foramen magnum (FM) meningiomas, preserving the arachnoid membrane. This technique offers a viable option for treating these tumors with good clinical outcomes.
Area of Science:
- Neurosurgery
- Neuro-oncology
- Spinal Surgery
Background:
- Ventral foramen magnum (FM) meningiomas present surgical challenges due to their location.
- Minimally invasive surgical approaches are continually being explored for complex cranial base tumors.
- The conventional posterior approach is typically used for posterior FM lesions, but its utility for ventral tumors is less established.
Purpose of the Study:
- To evaluate the efficacy and applicability of a conventional posterior approach for ventral foramen magnum meningiomas.
- To assess the feasibility of gross total resection without extensive lateral bony window modifications.
- To determine the safety and clinical outcomes associated with this surgical technique.
Main Methods:
- Retrospective analysis of 11 patients with ventral FM meningiomas treated between January 1999 and March 2011.
- All patients underwent a conventional posterior approach without extending the lateral bony window.
- Tumor removal was performed by exploiting the working space between the dura and arachnoid membrane, with minimal retraction of neural structures.
Main Results:
- Gross total resection (Simpson grade I or II) was achieved in all 11 patients.
- Clinical symptoms improved in eight patients and remained stable in three, with no recurrences during a median follow-up of 55 months.
- Postoperative complications were minimal, including one case of pseudomeningocele and one of transient dysphagia with dysarthria.
Conclusions:
- The conventional posterior approach, without a lateral approach, is a feasible and effective method for gross total resection of ventral foramen magnum meningiomas.
- The arachnoid membrane can be utilized as a natural barrier to protect neural structures during dissection.
- This surgical strategy requires a comprehensive understanding of anatomical limitations for optimal patient outcomes.
