The Sixth Annual International Neurosurgery Conference 2128 August 2010 Ajler Pablo Vecchi EKnezevich F Landriel FHem S Carrizo A pabloajlerhospitalitalianoorgar wwwhospitalitalianoorgar ID: 1048379
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1. Foramen Magnum MeningiomasThe Sixth Annual International Neurosurgery Conference21-28 August 2010Ajler Pablo Vecchi E,Knezevich F., Landriel F.,Hem S., Carrizo A.pablo.ajler@hospitalitaliano.org.ar www.hospitalitaliano.org.ar
2. ForamenMagnum(FM) Meningiomas HistoryFirst case of a FM meningioma was an autopsy finding by Hallopeau in 1872First successful removal was accomplished by Elsberg and Strauss in 1927
3. Foramen Magnum Meningiomas Most commonly observed FM tumors14-19% of intracranial tumors1.5 to 3.2% arises at the foramen magnum Ten percent have an extradural extension
4. Foramen Magnum Meningiomas Lesion is often large when discoveredSlow-growing rateIndolent developmentWide subarachnoid space at this levelPrerequisite for treating FM meningiomas is the perfect knowledge of the surgical anatomy
5. Limits of the FMAnterior border: lower third of the clivus and upper edge of the body of C2Lateral borders: jugular tubercles and upper aspect of C2 laminasPosterior border: anterior edge of the squamous occipital bone and C2 spinous processCourtesy Dr. Alvaro Campero
6. Osseous relationshipsVascular anatomyLower Cranial NervesForamen Magnum Meningiomas
7. Jugular foramenHypoglosal canalCarotid canalCondyle
8. Vascular Anatomy V3V4Courtesy Dr. Alvaro Campero
9. Lower Cranial NervesGlossopharingealVagusAccesoryHypoglossalCourtesy Dr. Alvaro Campero
10. Surgical Approach PlanningMagnetic Resonance Imaging (MRI) Computed Tomography (CT)AngiographyForamen Magnum Meningiomas
11. Surgical Approach Planning -Tumor Location-Intradural / extradural / intra-extraduralAnterior / lateral/ posteriorForamen Magnum Meningiomas
12. Far lateral or postero-lateral suboccipital (trans-condylar or retrocondilar)Midline PosteriorSurgical Approach
13. Surgical AspectsSitting PositionHead in neutral position (flexion worsen the compression)Somatosensory evoked potentialsBrainstem Auditory evoked potentials
14. Foramen Magnum Meningiomas Eigth (8) F.M. Meningiomas(2000-2010)Approach5 Far lateral3 Midline PosteriorResection100% GTR (gross total removal ) No mortalityInmediate Morbidity: 28.7% (2 patients)Long term morbidity: 14.28%(1 patient)
15. 43 y.o. femaleCervico-occipital painParesthesia upper limbs
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18. 36 yo femaleCervico occipital painGait ataxia
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21. 78 yo femaleCervico occipital pain progressive quadriparesis
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23. 66 yo femaleCervico occipital pain progressive quadriparesisGait ataxia
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26. Tumors of the foramen magnum present a formidable surgical challengeSeveral surgical approaches are possibleBig anterior and anterolateral FM meningiomas that displace the medulla/spinal cord can be safely and completely resected via a posterolateral suboccipital retrocondylar approach.Foramen Magnum Tumors
27. Resection of the occipital condyle should be tailored to individual casesSmall anterior or intra extradural tumors could be operated by an extreme lateral approachPostoperative complications can be dramatic and must be anticipatedForamen Magnum Meningiomas