Corresponding Author

Wahdan, Mahmoud

Subject Area


Document Type

Clinical Study


Background Data: Foramen magnum (FM) meningiomas are always considered challenging cases for neurosurgeons. The challenge is even heftier with early experience with limited access to up-to-date neurosurgical gadgets. Besides the anatomical complexity of the region, FM meningiomas tend to grow in proximity to eloquent structures making the task even tougher. Multiple approaches have been advocated to manage these lesions; nevertheless, adopting an approach according to your experience and circumstances would be best. Purpose: To present our experience with 16 cases of FM meningiomas operated via posterior suboccipital approach and discuss the validity of this approach. Study Design: A retrospective cohort study. Patients and Methods: We reviewed our hospital records for patients where the posterior suboccipital approach was performed for foramen magnum meningiomas in the period between November 2014 and January 2019 at our institution. Lesions with anterior location or limited posterolateral extension and those with vertebral artery encasement were excluded. We could trace 16 patients with FM meningiomas operated upon using the midline suboccipital approach. Patients’ imaging included IV gadolinium-enhanced MRI brain and CT angiography including brain and neck for diagnostic and planning purposes. Recorded outcome variables were pre- and postoperative Japanese Orthopedic Association (JAO) scale, extent of tumor excision according to Simpson’s grading, operative blood loss, duration of surgery, hospital stay, and perioperative complications. Follow-up data were recorded from our outpatient clinic chart records. Results: Twelve patients were females and 4 were males with a mean age of 40.64±8.69 years (range, 29–56 years). The mean preoperative JOA score improved from 14.875±1.690 to 15.63±0.99 at the last postoperative follow-up. Total resection was achieved in 10 cases (6, grade I; 4, grade II), subtotal resection in 4 patients, and partial resection in 2 patients. Patients with residual lesions (N=6) were managed with Gamma Knife. The mean operative time was 261.25±55.33; the mean blood loss was 682.5±84.19; the mean hospital stay was 7.25±2.05 days. Transient CSF leak was the most common recorded complication (N=9). The mean follow-up period was 13±7.186 months. Conclusion: Our data suggest that the posterior midline suboccipital approach is a safe and effective option in the management of FM meningiomas that are mainly posterior or posterolateral. (2019ESJ203)


Foramen magnum, Meningioma, Craniocervical junction, Suboccipital approach