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J Neurol Surg B Skull Base 2019; 80(01): 001-009
DOI: 10.1055/s-0038-1654702
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Surgical Outcomes, Complications, and Management Strategies for Foramen Magnum Meningiomas

Stephen T. Magill
1   Department of Neurological Surgery, University of California, San Francisco, California, United States
,
Maryam N. Shahin   *
1   Department of Neurological Surgery, University of California, San Francisco, California, United States
,
Calixto-Hope G. Lucas   *
1   Department of Neurological Surgery, University of California, San Francisco, California, United States
,
Adam J. Yen
1   Department of Neurological Surgery, University of California, San Francisco, California, United States
,
David S. Lee
1   Department of Neurological Surgery, University of California, San Francisco, California, United States
,
David R. Raleigh
1   Department of Neurological Surgery, University of California, San Francisco, California, United States
2   Department of Radiation Oncology, University of California, San Francisco, California, United States
,
Manish K. Aghi
1   Department of Neurological Surgery, University of California, San Francisco, California, United States
,
Philip V. Theodosopoulos
1   Department of Neurological Surgery, University of California, San Francisco, California, United States
,
Michael W. McDermott
1   Department of Neurological Surgery, University of California, San Francisco, California, United States
› Author Affiliations Disclosure of Funding This work was supported by the Linda Wolfe Meningioma Research Fund and the National Cancer Institute of the National Institutes of Health (1F32CA213944–01) to S.T.M.
A preliminary version of this work was presented at the 2016 North American Skull Base Society Annual Meeting in Scottsdale, AZ. The abstract of that presentation was published (J Neurol Surg B 2016; 77 - A033). This complete work has not been previously published or presented at the time of submission.
Further Information

Publication History

05 January 2018

15 April 2018

Publication Date:
28 May 2018 (online)

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Abstract

Objectives Foramen magnum meningiomas (FMM) are complex lesions because of their proximity to the brain stem and posterior cerebrovasculature. The objective of this study is to report surgical outcomes and complications after resection of FMM.

Methods A retrospective chart review was conducted on patients with FMM from 1998 to 2015. Univariate logistic regression and recursive partitioning analysis were used to identify risk factors associated with complications and extent of resection (EOR).

Results We identified 28 patients with FMM. Median follow-up was 5.9 years. Tumors were World Health Organization grade I (92.9%) or grade II (7.1%). The vertebral artery was completely encased (25%), partially encased (11%), or not encased (64%). Median size was 11.9 cm3. EOR was gross total (39%) and subtotal (61%). The observed recurrence rate was 4% (n = 1). There were 38 complications in 12 patients (43%), and 6 patients (21%) had complications requiring additional surgery. Complications included cerebrospinal fluid leak/hydrocephalus (n = 7, 25%), weakness (n = 4, 14%), numbness (n = 4, 14%), and cranial nerve deficits: IX, X (n = 4, 14%), XI (n = 2, 7%), XII (n = 5, 18%). Medical complications included pneumonia (n = 1, 4%) and meningitis (n = 1, 4%). Tumor volume greater than 14 cm3 (odds ratio [OR] = 21.7, p = 0.0010), any vertebral artery encasement (OR 6.1, p = 0.0386), and subtotal resection (OR 6.4, p = 0.0398) were significantly associated with complications. Tumor volume greater than 14 cm3 was also significantly associated with subtotal resection (OR 8.3, p = 0.0201).

Conclusions Resection of FMM carries perioperative morbidity that increases with larger tumor size. Despite the morbidity, long-term recurrence-free survival is achievable with maximal safe resection and adjuvant radiation.

Keywords

foramen magnum - meningioma - complications - outcomes - vertebral artery - surgical technique - approach - management

* These authors contributed equally to this article.


 

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