Background: Foramen Magnum Meningiomas (FMMs) represent a neurosurgical
challenge because they grow in close contact with osteoarticular, nervous, and vascular
structures that cannot be sacrificed or retracted. Objective: To evaluate our strategy and
results in six patients with FMMs and analyze factors affecting the decision-making
process, resection, and outcome. Patients and Methods: Six patients with foramen
magnum meningioma operated at Sohag University hospital in the period between 2007
and 2012 with an age ranged from 25-65 years and the sex distribution showed four
females and two males. All cases were examined clinically preoperative for the
neurological status. Cranial MRI was done for all cases preoperatively. One stage
operation was done for complete excision of the meningioma using a posterolateral
retrocondylar approach in the three quarter position. Postoperative assessment for the
neurological function and imaging study was done. Results: After surgical excision of
the meningioma assessment of the neurological state was done and all patients were
active and independent. One patient developed exaggerated and permanent ipsilateral
lower cranial nerve palsy. All patients improved in their motor power. Paresthesia and
sensory deficits resolved completely in four patients (60%). Respiratory dysfunction in
one patient resolved completely. No cases showed recurrence during the period of follow
up. Conclusion: Anterior and anterolateral FM meningiomas that displace the
medulla/spinal cord can be safely and completely resected via a posterolateral
suboccipital retrocondylar approach. A tumor remnant should be left on critical
neurovascular structures in cases with poor arachnoid dissection planes.