Extended Transcondylar Approach With C-1 Lateral Mass Resection for the Removal of a Calcified Ventral "Spinocranial" Meningioma: 2-Dimensional Operative Video.

Abstract

Originally reported by Hallopeau1 and subsequently described by Cushing as meningiomas that have subforaminal origin2 with intracranial extension through the foramen magnum,3 “spinocranial” meningiomas share the clinical risk profile associated with the meningiomas that originate intracranially with extension into the spinal canal—an entity referred to as “craniospinal” meningiomas.4 Although both are categorized under foramen magnum meningiomas, the spinocranial subtypes have distinct clinical and surgical characteristics. They are more likely to present primarily with sensory deficits with a relatively lower incidence of cranial nerve involvement5 and are frequently located lateral and posterolateral within the spinal canal, rendering them more amenable to total removal.6 However, ventrally located tumors present one of the most challenging surgical undertakings with the fear of potential devastating neurological deficits.7,8 To the author, these are the most fearsome of all meningiomas because the anterior spinal artery is at particular risk of injury with potentially devastating complications. Accordingly, a heavily calcified or ossified tumor in the ventral location mandates a more lateral or anterior approach for safe exposure and resection.9 We present a case of a ventrally placed, calcified, broad-based meningioma originating from the abaxial surface of C2, with rostral extension into the foramen magnum, while caudally extending to the level of C3. The patient underwent radical tumor resection through a lateral transcondylar and transcervical approach and required craniocervical stabilization, all with complete recovery of preoperative deficits and no recurrence at 5-year follow-up. The patient consented to the surgery and publication of their images. Images at 1:51 and 2:21 reprinted with permission from Al-Mefty O, Operative Atlas of Meningiomas. Vol 1, ©LWW, 1998. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_8kc7q3l5"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]}