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Benign extramedullary tumors of the foramen magnum
Abstract:
This paper analyzes the clinical, diagnostic and surgical data of 18 benign extramedullary tumors at the foramen magnum extending into the posterior fossa and the spinal canal. These cases represent 30% of 60 foramen magnum tumors operated on between 1952 and 1978, among 4187 brain tumors and 587 tumors of the spinal cord. Foramen magnum meningiomas constitute 11 of this series (1.2% of 873 meningiomas, 113 of which were spinal). The considerable difficulty in early diagnosis is emphasized. However, in the present series, myelography showed positive findings in all cases, and angiography in most of them. CT scan, performed in one case, demonstrated the lesion. Surgical mortality was 11% (two deaths). On both patients who died after the operation, multiple surgical procedures had been performed because of erroneous diagnoses made in another unit. At the time of operation neurological symptoms were very advanced, and large tumors were located anteriorly. The review of the remaining patients showed a regression of preoperative symptoms with good to excellent results in all. No recurrences were recorded.
Insights
Benign extramedullary tumors at the foramen magnum can be challenging to diagnose early. However, surgical intervention leads to symptom improvement and no recurrences in most patients.
Area of Science:
- Neurosurgery
- Oncology
- Neurology
Background:
- This study reviews 18 cases of benign extramedullary tumors at the foramen magnum, a subset of tumors affecting the brain and spinal cord.
- These tumors represent a significant portion (30%) of foramen magnum tumors operated on during the study period.
Observation:
- Early diagnosis of these tumors is often difficult.
- While computed tomography (CT) was used in only one case, myelography and angiography proved valuable diagnostic tools, showing positive findings in most cases.
- Surgical mortality was 11%, with deaths occurring in patients with advanced symptoms and multiple prior procedures due to misdiagnosis.
Findings:
- All patients who underwent surgery without prior misdiagnosis showed symptom regression, with good to excellent outcomes.
- No tumor recurrences were observed in the reviewed cases.
- Foramen magnum meningiomas were the most common type in this series.
Implications:
- Accurate and timely diagnosis is crucial for successful surgical outcomes.
- Surgical intervention for benign extramedullary tumors at the foramen magnum can yield significant long-term benefits.
- Further research into advanced diagnostic imaging may improve early detection rates.