Department of Neurosurgery, International Neuroscience Institute, Rudolf Pichlmayr Str. 4, 30625, Hannover, Germany.
Department of Human Neurosciences, Neurosurgery, University of Rome, "Sapienza", Rome, Italy.
Neurosurg Rev. 2019 Dec;42(4):859-866. doi: 10.1007/s10143-018-01060-6. Epub 2018 Dec 1.
Foramen magnum meningiomas (FMMs) are challenging lesions and controversy still exists regarding their optimal management. In the present paper, we propose some principles of surgical treatment of FMMs. We analyzed our series of 39 patients: the average maximum diameter was 31.1 mm (sd, 10.7). In two cases, there was extradural extension. We operated all anterior lesions through dorsolateral approach to craniovertebral junction and all posterior lesions through midline suboccipital approach and C1 laminectomy, following the prevalence of side of the tumor. There were no complications except for one case of post-operative hypoglossus paresis. We translated our experience with surgery of foramen magnum meningiomas into a classification system and a complexity score, in order to assign a score to each individual case and plan the surgical strategy. When the complexity score is 5 or more, we propose subtotal removal, in consideration of the benign nature.
枕骨大孔脑膜瘤（FMMs）是具有挑战性的病变，其最佳治疗方法仍存在争议。在本文中，我们提出了 FMMs 的手术治疗原则。我们分析了我们的 39 例患者系列：平均最大直径为 31.1mm（标准差，10.7）。在 2 例中，存在硬膜外延伸。我们通过颅颈交界部的外侧入路和中线枕下入路和 C1 椎板切除术对所有前病变进行手术，根据肿瘤的侧别进行操作。除 1 例术后舌下神经麻痹外，无其他并发症。我们将手术治疗枕骨大孔脑膜瘤的经验转化为一种分类系统和复杂性评分，以便对每个病例进行评分并制定手术策略。当复杂性评分为 5 分或更高时，我们建议进行次全切除，考虑到其良性性质。
