Suboccipital Partial Transcondylar Approach in Management of Antrolateral and Anterior Foramen Magnum Meningiomas, Surgical Experience

Background: Antrolateral and anterior foramen magnum meningiomas remain one of the most challenging pathologies in neurosurgery because they are in close contact with nervous, vascular and articular structures that can not be scarified or retracted. Objective: This is a retrospective case series study that analyzes the postoperative clinical and radiological outcome of nine patients with antrolateral and anterior foramen magnum meningiomas operated upon in the Neurosurgery Department, Cairo University Hospital. Patients and Methods: Patient selection: seven patients with antrolateral and two patients with anterior foramen magnum meningiomas were operated upon and followed up clinically and radiologically for one year. Operation: Microsurgical excision of the tumor using suboccipital partial transcondylar approach. Results: Between Jan 2009 and December 2013, nine patients underwent operation for foramen magnum meningiomas using suboccipital partial transcondylar approach and followed up clinically and radiologically for twelve months . The tumor attachment was antrolateral in seven patients (77.8%) and anterior in two patients (22.2%). Total tumor removal was accomplished in 100% of the patients .Transient morbidity rate was 66.7% which all recovered by six months follow up interval. No permanent surgical morbidity or mortality were encountered. Eight patients (88.9%) had regained full daily activity. No recurrence was observed after a follow up period of one year. Conclusion: Antrolateral and anterior foramen magnum meningiomas can be removed gross totally using the suboccipital partial transcondylar approach. It allows adequate exposure of the important neurovascular structures in this region with no or minimal retraction.