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Foramen magnum meningioma: long-term follow up without neurosurgery-A case report
Marija Djukic1,2, Johannes Gossner3, Jörg Larsen4,3
1Department of Neuropathology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
Background:
Foramen magnum meningiomas can cause lower cranial nerve deficits or brain stem symptoms. When they become symptomatic or when growth is documented, surgical resection is indicated.
Case Presentation:
In a white German 79-year-old woman, a small dorsal foramen magnum meningioma was detected by cerebral magnetic resonance imaging. After 7 years, cerebral magnetic resonance imaging showed considerable tumor growth (an increase in diameters from 15 × 16 × 20 mm to 28 × 30 × 37 mm), brain stem compression, and obstructive hydrocephalus. The clinical symptoms were however mild. The patient refused surgery. After a follow-up of over 18 months, she is still able to walk and live relatively independently.
Conclusions:
In the case of a slowly growing presumed benign intracranial tumor, deferral of surgery may be a justifiable option in old age, when symptoms are mild and social factors present an obstacle to immediate surgery. Since a spontaneous reduction in the growth rate is often observed in large intracranial meningiomas, some patients can survive with moderate deficits and a high quality of life in spite of substantial compression of the brain stem.
Insights
Foramen magnum meningiomas can cause symptoms. In elderly patients with mild symptoms, delaying surgery for slow-growing tumors may be a viable option, preserving quality of life.
Area of Science:
- Neurosurgery
- Neurology
- Oncology
Background:
- Foramen magnum meningiomas can lead to lower cranial nerve deficits and brain stem symptoms.
- Surgical resection is typically indicated for symptomatic or growing tumors.
Purpose of the Study:
- To evaluate the management of a foramen magnum meningioma in an elderly patient who refused surgery.
- To assess the feasibility of deferring surgical intervention for slow-growing intracranial tumors in the elderly.
Main Methods:
- A 79-year-old woman with a dorsal foramen magnum meningioma was monitored via serial cerebral magnetic resonance imaging over 7 years.
- Tumor growth, brain stem compression, and hydrocephalus were assessed.
- Clinical status and quality of life were evaluated during an 18-month follow-up after the patient refused surgery.
Main Results:
- The meningioma demonstrated significant growth from 15x16x20 mm to 28x30x37 mm, causing brain stem compression and obstructive hydrocephalus.
- Despite tumor progression, the patient experienced only mild clinical symptoms.
- The patient maintained the ability to walk and live relatively independently throughout the follow-up period.
Conclusions:
- Deferral of surgery may be a justifiable option for presumed benign, slow-growing intracranial tumors in elderly patients with mild symptoms and social obstacles to surgery.
- Spontaneous reduction in growth rate is common in large intracranial meningiomas.
- Some patients can maintain a high quality of life with moderate deficits despite significant brain stem compression.
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