Microsurgical management of foramen magnum meningiomas (FMMs) can be associated with significant morbidity and mortality. Stereotactic radiosurgery may be an efficient and safe alternative treatment modality for such tumors. The object of this study was to increase the documented experience with Gamma Knife surgery (GKS) for FMMs and to delineate its role in an overall management paradigm.
The authors report on their experience with 24 patients harboring FMMs managed with GKS. Twelve patients had primary symptomatic tumors, 5 had asymptomatic but enlarging primary tumors, and 7 had recurrent or residual tumors after a prior surgery.
Follow-up clinical and imaging data were available in 21 patients at a median follow-up of 47 months (range 3–128 months). Ten patients had measurable tumor regression, which was defined as an overall volume reduction > 25%. Eleven patients had no further tumor growth. Two patients died as a result of advanced comorbidities before follow-up imaging. One patient was living 8 years after GKS but had no clinical evaluation. Ten of 17 symptomatic patients with at least 6 months of follow-up had symptom improvement, and 7 remained clinically stable. Smaller tumors were more likely to regress. No patient suffered an adverse radiation effect after radiosurgery.
Gamma Knife surgery was a safe management strategy for small, minimally symptomatic, or growing FMMs as well as for residual tumors following conservative microsurgical removal.
Please include this information when citing this paper: published online September 14, 2012; DOI: 10.3171/2012.8.JNS111554.
AkalanN,,SeçkinH,,KiliçC,&OzgenT:Benign extramedullary tumors in the foramen magnum region.Clin Neurol Neurosurg96:284–289,1994
ArnautovićKI,,Al-MeftyO,&HusainM:Ventral foramen magnum meninigiomas.J Neurosurg92:1 Suppl71–80,2000
BabuRP,,SekharLN,&WrightDC:Extreme lateral transcondylar approach: technical improvements and lessons learned.J Neurosurg81:49–59,1994
BassiouniH,,NtoukasV,,AsgariS,,SandalciogluEI,,StolkeD,&SeifertV:Foramen magnum meningiomas: clinical outcome after microsurgical resection via a posterolateral suboccipital retrocondylar approach.开云体育app官方网站下载入口59:1177–1187,2006
BertalanffyH,,GilsbachJM,,MayfrankL,,KleinHM,,KawaseT,&SeegerW:Microsurgical management of ventral and ventrolateral foramen magnum meningiomas.Acta Neurochir Suppl65:82–85,1996
BorbaLA,,de OliveiraJG,,Giudicissi-FilhoM,&ColliBO:Surgical management of foramen magnum meningiomas.Neurosurg Rev32:49–60,2009
BoultonMR,&CusimanoMD:Foramen magnum meningiomas: concepts, classifications, and nuances.Neurosurg Focus14:6e10,2003
BruneauM,&GeorgeB:Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisière Hospital and review of the literature.Neurosurg Rev31:19–33,2008
CheshierSH,,HanftSJ,,AdlerJR,&ChangSD:CyberKnife radiosurgery for lesions of the foramen magnum.Technol Cancer Res Treat6:329–336,2007
CrockardHA,&SenCN:The transoral approach for the management of intradural lesions at the craniovertebral junction: review of 7 cases.开云体育app官方网站下载入口28:88–98,1991
GeorgeB,Meningiomas of the foramen magnum.SchmidekHH:Meningiomas and Their Surgical ManagementPhiladelphia,Saunders,1991.459–470
GeorgeB,,DematonsC,&CophignonJ:侧的前部分fo方法ramen magnum. Application to surgical removal of 14 benign tumors: technical note.Surg Neurol29:484–490,1988
GeorgeB,,LotG,&BoissonnetH:Meningioma of the foramen magnum: a series of 40 cases.Surg Neurol47:371–379,1997
GuidettiB,&SpalloneA:Benign extramedullary tumors of the foramen magnum.Surg Neurol13:9–17,1980
KandenweinJA,,RichterHP,&AntoniadisG:Foramen magnum meningiomas—experience with the posterior suboccipital approach.Br J Neurosurg23:33–39,2009
KanoT,,KawaseT,,HoriguchiT,&YoshidaK:Meningiomas of the ventral foramen magnum and lower clivus: factors influencing surgical morbidity, the extent of tumour resection, and tumour recurrence.Acta Neurochir (Wien)152:79–86,2010
KratimenosGP,&CrockardHA:The far lateral approach for ventrally placed foramen magnum and upper cervical spine tumours.Br J Neurosurg7:129–140,1993
MargalitNS,,LesserJB,,歌手M,&SenC:Lateral approach to anterolateral tumors at the foramen magnum: factors determining surgical procedure.开云体育app官方网站下载入口56:2 Suppl324–336,2005
Marin SanabriaEA,,EharaK,&TamakiN:Surgical experience with skull base approaches for foramen magnum meningioma.Neurol Med Chir (Tokyo)42:472–480,2002
MenezesAH:Surgical approaches: postoperative care and complications “posterolateral-far lateral transcondylar approach to the ventral foramen magnum and upper cervical spinal canal.Childs Nerv Syst24:1203–1207,2008
MeyerFB,,EbersoldMJ,&ReeseDF:Benign tumors of the foramen magnum.J Neurosurg61:136–142,1984
MillerE,&CrockardHA:Transoral transclival removal of anteriorly placed meningiomas at the foramen magnum.开云体育app官方网站下载入口20:966–968,1987
MuthukumarN,,KondziolkaD,,LunsfordLD,&FlickingerJC:Stereotactic radiosurgery for anterior foramen magnum meningiomas.Surg Neurol51:268–273,1999
NandaA,,VincentDA,,VannemreddyPS,,BaskayaMK,&ChandaA:Far-lateral approach to intradural lesions of the foramen magnum without resection of the occipital condyle.J Neurosurg96:302–309,2002
PamirMN,,KilicT,,OzdumanK,&TureU:Experience of a single institution treating foramen magnum meningiomas.J Clin Neurosci11:863–867,2004
ParlatoC,,TessitoreE,,SchonauerC,&MoraciA:Management of benign craniovertebral junction tumors.Acta Neurochir (Wien)145:31–36,2003
PirotteB,,DavidP,,NotermanJ,&BrotchiJ:Lower clivus and foramen magnum anterolateral meningiomas: surgical strategy.Neurol Res20:577–584,1998
PirotteBJ,,BrotchiJ,&DeWitteO:Management of anterolateral foramen magnum meningiomas: surgical vs conservative decision making.开云体育app官方网站下载入口67:3 Suppl Operativeons58–ons70,2010
RobertiF,,SekharLN,,KalavakondaC,&WrightDC:Posterior fossa meningiomas: surgical experience in 161 cases.Surg Neurol56:8–21,2001
SalasE,,SekharLN,,ZiyalIM,,CaputyAJ,&WrightDC:Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients.J Neurosurg90:2 Suppl206–219,1999
SamiiM,,KlekampJ,&CarvalhoG:Surgical results for meningiomas of the craniocervical junction.开云体育app官方网站下载入口39:1086–1095,1996
SenCN,&SekharLN:An extreme lateral approach to intradural lesions of the cervical spine and foramen magnum.开云体育app官方网站下载入口27:197–204,1990
StarkeRM,,NguyenJH,,ReamesDL,,RaineyJ,&SheehanJP:Gamma knife radiosurgery of meningiomas involving the foramen magnum.J Craniovertebr Junction Spine1:23–28,2010
United Nations:World Population Prospects, the 2010 RevisionNew York,Department of Economic and Social Affairs, Population Division,(http://esa.un.org/wpp/Sorting-Tables/tab-sorting_mortality.htm) [Accessed August 16, 2012]
WuZ,,HaoS,,ZhangJ,,ZhangL,,JiaG,&TangJ,et al.:Foramen magnum meningiomas: experiences in 114 patients at a single institute over 15 years.Surg Neurol72:376–382,2009
YaşargilMG,&CurcicM,Meningiomas of basal posterior cranial fossa.KrayenbuhlH:Advances and Technical Standards in NeurosurgeryVienna,Springer-Verlag,7:1–115,1980
YasuokaS,,OkazakiH,,DaubeJR,&MacCartyCS:Foramen magnum tumors. Analysis of 57 cases of benign extramedullary tumors.J Neurosurg49:828–838,1978
All Time | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 2326 | 820 | 32 |
Full Text Views | 206 | 8 | 0 |
PDF Downloads | 94 | 15 | 0 |
EPUB Downloads | 0 | 0 | 0 |