Presentation
It often presents with occipitocervical pain, long tract signs, and lower cranial nerve deficits [2, 3]. Drop attack as a presenting symptom of meningioma of foramen magnum has never been reported. [hindawi.com]
Two cases of atypical foramen magnum meningioma presenting as rotatory paralysis. J Neurol Stroke. 2019;9(4):180-182. [medcraveonline.com]
Maroc Patient 33 years, female Clinical History A 33-year-old female presented with a 1-year history of mild headache. Imaging Findings A 33-year-old female presented with a 1-year history of mild headache. [eurorad.org]
1 Introduction Foramen magnum meningiomas (FMMs) originates from the arachnoid cells at the dura matter of the craniocervical junction.[1,2] Location wise, FMMs forms about 2.6% of all meningiomas.[1,3] Clinically, presentation of FMMs is nonspecific [journals.lww.com]
Case report: We report a case of a 79-year-old male patient, presented with ataxia and sense of threatening fainting during verticalization. Magnetic resonance imaging revealed the presence of meningioma in the right side of craniospinal junction. [bibliomed.org]
Entire Body System
- Asymptomatic
And regarding the another lesion, as it is asymptomatic & currently patient & her relative not agree to go for another surgery so our plan is regular follow up of the patient. [medcraveonline.com]
Adverse radiation effects were classified as asymptomatic, symptomatic and temporary, and symptomatic and permanent. [thejns.org]
Observation is reasonable for small asymptomatic lesions or minimally symptomatic lesions in older patients. [neurosurgicalatlas.com]
Number of patients Asymptomatic 1 Cervico-occipital pain 5 Headache and dizziness 9 Dysphagia 1 Hoarseness 2 Paraparesis 5 Ataxic gait 5 Hypoaesthesia 2 Table 2: Operative approach and results in patients with FM meningioma. [ajns.paans.org]
- Severe Pain
Pre-operative karnofsky performance scales (0-death 100-very good health) were used in order to evaluate the life quality of the patients and visual analog scales (0-no pain, 10-very severe pain) (VAS) were used in order to rate the neck pains. [panafrican-med-journal.com]
Gastrointestinal
- Hiccup
Another complication involved the nerves in the brainstem that control swallowing, hiccups and other functions. "These nerves were stretched by the tumor," Dr. Tobler says. [mayfieldclinic.com]
Neurologic
- Meningism
Four meningeal vessels participate to the vascular supply of the FM dura mater: the anterior and posterior VA meningeal arteries, and meningeal branches of the ascending pharyngeal and occipital arteries.[20,21,36] Infrequently, meningeal branches arise [ncbi.nlm.nih.gov]
Meningeal tumor obstructing the foramen magnum is relatively rare and until recently has seldom been diagnosed ante mortem. [jamanetwork.com]
The dural blood supply involves the posterior and anterior meningeal branches from the vertebral arteries as well as the meningeal branches via ascending pharyngeal and occipital arteries. [neurosurgicalatlas.com]
For lateral and anterior FM meningiomas, the transoral approach has been several drawbacks, especially for intradural lesions, including cerebro-spinal fluid fistula and meningitis (8, 10, 27). [ajns.paans.org]
Keyword: atypical meningioma, foramen magnum, craniospinal junction, far lateral approach, rotatory paralysis Introduction Meningioma is extra axial tumor originate from arachnoid cap cells found in the arachnoid layer of meninges. [medcraveonline.com]
- Ataxia
Case report: We report a case of a 79-year-old male patient, presented with ataxia and sense of threatening fainting during verticalization. Magnetic resonance imaging revealed the presence of meningioma in the right side of craniospinal junction. [bibliomed.org]
Headache improved in 17 of 20 patients with pre-SRS headache, numbness improved in 7 of 18 patients with pre-SRS numbness, ataxia improved in 5 of 17 patients with pre-SRS ataxia, weakness improved in 4 of 12 patients with pre-SRS weakness, and cranial [thejns.org]
Long tract signs such as hyperreflexia, Babinski response, and ataxia are evidence of upper motor neuron dysfunction. [neurosurgicalatlas.com]
FMMs are typically slow growing with an indolent course, but when they become symptomatic, they most commonly present with quadriparesis, sensory abnormalities, ataxia, and dysfunction of cranial nerves (CN) IX and X.6 The classic presentation of weakness [medcraveonline.com]
While 18% (2 patients) had ataxia, 18% (2 patients) had weakness in arms, 18% (2 patients) had quadriparesis, 9% (1 patient) had difficulty of swallowing, neurological examination in 37% (4 patients) was normal. [panafrican-med-journal.com]
- Stroke
Dwight did experience a mini-stroke during the surgery, and he continues to lack sensation in his left shoulder. Another complication involved the nerves in the brainstem that control swallowing, hiccups and other functions. [mayfieldclinic.com]
J Neurol Stroke. 2019;9(4):180-182. DOI: 10.15406/jnsk.2019.09.00373 Download PDF Abstract Meningiomas are the most common benign intracranial neoplasms accounting for 13 to 19% of all intracranial tumors. [medcraveonline.com]
- Cranial Nerve Involvement
She did not have any other manifestation involving the sensory system or the cranial nerve. [medcraveonline.com]
In our study, temporary lower cranial nerve (IX, X) involvement and dysphagia developed in 2 of our patients (18%) with anterolateral and anterior localizations, to whom we performed far lateral interventions. [panafrican-med-journal.com]
Nine of the patients studied presented with motor deficits, lower cranial nerve involvement and intracranial hypertension. The onset of the clinical signs was mainly insidious. [ajns.paans.org]
- Irritability
"As the tumor was carefully removed, these stretched nerves were carefully preserved and became 'un-stretched.' " The resulting irritation, which was necessary, caused a hiccup reflex that lasted for several days. [mayfieldclinic.com]
Workup
Cardiovascular workup which included echocardiograms (ECG) and Holter monitoring were normal. [hindawi.com]
Treatment
Treatment Available Treatments depend on whether you are experiencing symptoms. If you are, we often recommend completely removing the tumor surgical resection. We determine the specific surgical approach based on the size and location of the tumor. [mountsinai.org]
Poulsgaard highlights the surgical treatment of large vestibular schwannomas. Surgical treatment of large vestibular schwannomas L Poulsgaard [websurg.com]
Given the overall infrequency of FMMs, treatment outcomes and optimal management paradigms remain poorly defined. For several decades, resection has been the treatment of choice for these tumors. [thejns.org]
They recorded 4 cases in which surgical treatment was attempted, in all of which the termination was fatal. Since 1937 about 35 cases have been reported in which various kinds of tumors obstructing the foramen magnum were successfully removed. [jamanetwork.com]
The aim of this study is to analyse short- and long-term results after surgical treatment of foramen magnum meningiomas and to identify the possible advantages of the posterior suboccipital approach over lateral and anterior approaches. [tandfonline.com]
Prognosis
Introduction Meningiomas are generally benign, and they are the tumors with good prognosis. Foramen magnum meningiomas constitute 1.8-3.2% of all meningiomas [1-4]. They are observed more frequently in fifth and sixth decades [5-8]. [panafrican-med-journal.com]
Etiology
Foramen magnum meningioma: dysphagia of atypical etiology. J Gen Intern Med. 2008;23(2):206-209. WARA WM, SHELINE GE, NEWMAN H, TOWNSEND JJ, BOLDREY EB. Radiation therapy of meningiomas. Am J Roentgenol. Radium Ther Nucl Med. 1975;123:453-458. [ajns.paans.org]
Epidemiology
Epidemiology of intracranial meningioma. Neurosurgery. 2005;57(6):1088–1095. Richardson AM, Au K, Morcos J. Foramen Magnum Meningiomas. In Skull Base Surgery of the Posterior Fossa 2018. Springer, Cham. 2018. p. 135–143. ©2019 Haque, et al. [medcraveonline.com]
With this systematic review and meta-analysis, our goal is to detail epidemiology, clinical features, surgical aspects, and outcomes of this rare pathology. [link.springer.com]
Prevention
Suboccipital craniotomy bone which was repositioned with mini-plate and mini-screw and C1 laminoplasty may prevent excess bone loss; a positive cosmetic appearance may be achieved and cervical instability may be prevented. (Figure 5). [panafrican-med-journal.com]
Care must be taken to prevent the tumor capsule from abruptly returning in the medial direction to its original state and injuring the spinal cord. [neurosurgicalatlas.com]
Moreover surgery with radiation in compare to surgery alone doesn’t show any beneficial effect.10,12,13 However from literature we can say that radiation therapy has no role in preventing recurrence rate of atypical meningioma after gross total resection [medcraveonline.com]
Intensive pulmonary care, aggressive pulmonary toilet, and antibiotic prophylaxis are used to prevent fatal respiratory complications in patients with deficits of the lower cranial nerves. [ajns.paans.org]
This limitation ultimately prevents proper comparison between cohorts and centers and their surgical results in a long-term fashion. [link.springer.com]