Foramen Magnum Meningiomas: The Extreme Lateral Approach

Meningiomas of the foramen magnum are considered a separate group of tumors because of their clinical presentation, surgical considerations, and clinical outcome. These are rare tumors that account for 1.8 to 3.2% of all meningiomas and 6 to 7% of all posterior fossa meningiomas. Many publications have appeared over the last two decades highlighting the virtues of an increasingly lateral approach to tumors at the anterior aspect of the foramen magnum. Selection of a lateral approach over a more conventional suboccipital approach and management of the occipital condyle and the vertebral artery are issues that are still debated. We present the clinical presentation, radiological findings, an anatomical description, and the principles of the surgical technique we use for these tumors. The results for 18 patients with anterior and anterolateral foramen magnum meningiomas treated surgically by the senior author are presented as well.