Foramen Magnum Meningiomas: Case Series And Review Of Literature

Abstract

Meningiomas are extra-axial central nervous system lesions occurring at any location where arachnoid cap cells reside. They represent up to 20% of all intracranial tumors and are the commonest non-glial primary intracranial neoplasm. Despite the vast majority being benign and slow-growing, their myriad presenting locations and sometimes locally invasive nature have sharply contrasting implications in clinical presentation and management. In the region of the foramen magnum, they account for 1.8 to 3.2% of all meningiomas which represent 75% of benign tumors in this location. True to the nature of meningiomas, they occur more frequently on females and are rare in childhood. Their indolent development at the cranio-spinal junction complicates their clinical presentation and often leads to a long interval between onset of symptoms and diagnosis. Critical neurovascular relations and their sensitivity to surgical manipulation make their complete resection a great challenge to the experienced neurosurgeon and a nightmare to the novice. Satisfying results can however be obtained with carefully planned approaches tailor-made to suit different configurations of foramen magnum meningiomas. Herein, we present 2 cases of patients with foramen magnum meningiomas recently managed in our neurosurgical unit. Their clinical presentation, surgical management and post-operative course are detailed with the inherent challenges faced highlighted. A review of the current literature is further provided, emphasizing the complex nature of these lesions and the nuanced neurosurgical approaches required to achieve maximal resection with preservation and/or improvement of neurological function.