Microsurgical resection of foramen magnum meningioma through a transcondylar approach: three-dimensional operative video.

Guilherme H W Ceccato,Luis A B Borba,Rodolfo F M Da Rocha,Duarte N C Cândido,Marcio S Rassi,Wladimir O Melo

doi:10.3171/2019.10.focusvid.19465

Abstract

Foramen magnum (FM) meningiomas are challenging lesions. We present the case of a 38-year-old female with neck pain, dysphonia, and slight twelfth nerve palsy. Imaging workup was highly suggestive of an FM meningioma, and microsurgical resection with the aid of intraoperative neurophysiological monitoring was indicated. A transcondylar approach was employed, the vertebral artery was mobilized, and the tumor was completely removed. Postoperative MRI demonstrated complete resection. There were no signs of cervical instability. The patient presented with improvement of her symptoms and no new neurological deficit on follow-up. FM meningiomas can be successfully resected using a transcondylar approach, since it increases the exposure of the ventral FM, allowing the surgeon to work parallel to the skull base and flush with the tumor’s attachment. Informed consent was obtained from the patient for publication of this operative video.The video can be found here: https://youtu.be/itfUOB-6zM0.

Highlights

0:20 Presentation and clinical history This is a three-dimensional operative video of the microsurgical resection of foramen magnum meningioma through a transcondylar approach
The patient was a 38-year-old female presenting a history of neck pain, dysphonia, and a slight XII nerve palsy
1:39 Anatomy In these anatomical pictures we review the steps of the procedure, but the approach that will be employed in this case is more lateral than in this anatomical demonstration

Summary

Introduction

0:20 Presentation and clinical history This is a three-dimensional operative video of the microsurgical resection of foramen magnum meningioma through a transcondylar approach. We should note that in this step the vertebral artery is released from the foramen transversarium, in order to allow mobilization of the vessel away from the condyle (Wen et al, 1997; Bruneau and George, 2008). The occipital and atlantal condyles is removed, increasing the exposure of the ventral foramen magnum (Wanebo and Chicoine, 2001; Muthukumar et al, 2005; Rhoton, 2000). Reflecting the splenius, we look better the semispinalis capitis and observe the longissimus muscle.

Results

Conclusion