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  • Title: Far Lateral Approach for Resection of a Foramen Magnum Meningioma: 3-Dimensional Surgical Video.
    Author: Campero A, Emmerich J, Marquez Rivas J.
    Journal: Oper Neurosurg (Hagerstown); 2020 Mar 01; 18(3):E81. PubMed ID: 31173144.
    Abstract:
    We present the case of a meningioma of the foramen magnum, in a patient of age 62 yr, who presented at the time of surgery a hemiparesis on the right side at 2 mo of evolution. The patient gave his informed consent for the publication of the case, and approval was obtained from the research department of the hospital where the procedure was performed.  The magnetic resonance imaging (MRI) in the mid-sagittal view shows a meningioma of the foramen magnum, with an extension in the posterior fossa and in the upper part of the cervical canal. In the coronal view and in the axial view, we can identify that although it is a meningioma of the anterior part of the foramen magnum, it is observed that the lesion has a displacement towards the right side.  In a cadaveric specimen, we show the normal anatomy and the key landmarks for performing the approach.  The patient was treated by a far lateral approach with a partial removal of the condyle. We show the craniectomy and the microsurgical technique for the tumor resection step by step. We paid particular attention in the anatomy surrounding the tumor and the tips and tricks for a safe resection.  We reached a total resection with a good outcome; the result of the anatomopathological study confirmed the diagnosis of meningothelial meningioma.  The dura was closed in a hermetic manner with a synthetic dura patch; then sealant was placed. The bone defect was corrected by placing a mesh in titanium. Then the flap was closed as usual.  The patient has a good evolution with 1 yr of follow-up and without lesion in the control MRI.
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