Surgical Approaches for Tumors Around Foramen Magnum and Craniocervical Junction

The authors treated 26 cases of extramedullary tumors around foramen magnum and craniocervical junction by various surgical approaches between 1982 and February 1993. They are 12 meningiomas, 9 neurinomas, 3 chordomas, 1 teratoma and 1 capillary lymphangioma. Among them, 7 cases are located at anterior portion of foramen magnum, 6 cases at anterolateral portion, 2 cases at lateral portion, 7 cases at posterolateral portion, and 4 cases are posteriorly located. These tumors were attacked via various surgical approaches. 19 cases were treated by conventional suboccipital approach, 5 cases by far lateral suboccipital approach and 2 cases of chordoma by transoral approach which was combined with far lateral suboccipital approach. So, 19 cases of tumors were removed completely, but 7 cases were subtotally removed. There was 1 case of operative mortality and in 2 cases of meningioma there was permanent lower cranial nerve palsy. Pyogenic meningitis due to CSF leakage developed in 2 cases of chordoma which were treated by transoral approach.

Foramen Magnum Tumors

Foramen magnum tumors are uncommon. We experienced two cases of foramen magnum tumor. One case was meningioma, the other neurinoma. Metrizamide computerized tomography scanning and pantopaque myelography have been the radiographic test most commonly used to evaluate the foramen magnum. Moth cases underwent suboccipital craniectomy and total laminectomy in C1 & C2 with total removal of tumor mass. Postoperatively, both cases showed improvement without neurological sequelae. Both cases are discussed, and a review of literature is presented.

TUMORS IN THE VICINITY OF FORAMEN MAGNUM / 解放军医学杂志

A series of 12 cases of tumors located in the vicinity of foramen magnum are reported. Among them 4 were cranio-spinal type and 8 spino-cranial type. Pathologically 4 were neuofibromas,3 meningio-mas, 2 lipomas, 1 astrocytoma, 1 ependymoma and 1 chordoma. Most patients manifested upper cervical nerve root symptoms. In the cranio-spinal type, impairment of IX X XI XII cranial nerves and slight pyramidal symptoms were often seen.In spino-cranial type, paralysis and loss of sensation were promi-nant.Lumbar puncture and Queckenstedt test were done in 8 cases, and in 7 cases there was obstruction of spinal canal. CT scans of the cranium and upper cervical region were performed in 12 cases, and in 11 cases space-occupying lesions were revealed. CT scan was negative in one patient, and the diagnosis was established by amipaque meylography. Operations were done in all cases. In 2 cases belonging to craniospinal type, tumors were totally removed, and in other 2 cases tumors were subtotally removed. In four cases of extramedullary spino-cranial type, tumors were tollally removed. In 4 cases of intramedullary tumors, only in one case the tumor (ependymoma) was totally removed by CUSA. There was no operative mortality in this series. The diagonsis, differential diagnosis and operative technics were discussed.