Foramen Magnum Meningioma Presenting with Cough Syncope (Case Report and Review of the Literature)

2018 ◽  
Vol 37 (04) ◽  
pp. 334-338
Author(s):  
Metin Kaplan ◽  
Omer Hepgunsel ◽  
Selman Kok ◽  
Murat Gonen
Keyword(s):  
Cranial Nerves ◽  
Contralateral Side ◽  
Foramen Magnum ◽  
Posterolateral Approach ◽  
Resonance Imaging ◽  
Vertebral Arteries ◽  
Neural Axis ◽  
C2 Vertebra ◽  
Magnetic Resonance Imaging Mri ◽  
Lower Cranial Nerves

AbstractForamen magnum meningiomas cause different symptoms based on the size and the location of the tumor. They often present with involvement of the long tracts and of the lower cranial nerves. Ataxia and occipitocervical headache are other common symptoms. In the present study, we report a case of foramen magnum meningioma presenting with cough syncope. A mass lesion located anterolateral to the foramen magnum was detected in a 38-year-old man during a magnetic resonance imaging (MRI) exam; the lesion extended from the inferior clivus to the level of the C2 vertebra. The neural axis has pushed towards posterior and contralateral side by the mass. We think that syncope occurred due to the encasement of the vertebral arteries by the tumor in addition to the compression of the neural axis. The posterolateral approach without condylar resection provides a safe surgical plane for total excision of these tumors. In our case, the tumor was totally removed and the syncope episodes were resolved.

Primary brain stem tethering: a rare cause of geniculate neuralgia

1999 ◽  
Vol 113 (10) ◽  
pp. 945-947 ◽  
Author(s):  
Geert G. Buyse ◽  
Jo Caekebeke ◽  
Philippe Demaerel ◽  
Chris Plets
Keyword(s):  
Brain Stem ◽  
Unusual Case ◽  
Cranial Nerves ◽  
Resonance Imaging ◽  
Considerable Decrease ◽  
Magnetic Resonance Imaging Mri ◽  
Fitting In ◽  
Lower Cranial Nerves ◽  
The Brain ◽  
Subcutaneous Lipoma

AbstractThis rare case of brain stem tethering presented with chronic and progressive geniculate neuralgia. In view of the fact that an occipital subcutaneous lipoma had been resected in childhood, it probably concerned a primary tethering, fitting in with an occult occipital dysraphism.Magnetic resonance imaging (MRI) clearly demonstrated an underlying tethering, causing a distortion of the brain stem. Consequently, this led to the hypothesis that the geniculate neuralgia could be explained by traction on the lower cranial nerves secondary to the brain stem displacement. Untethering resulted in a considerable decrease of the neuralgia.MRI proved to be essential in the diagnosis and treatment of this unusual case.

scholarly journals Pyramidal and Proprioceptive Dysfunctions as the Main Neurologic Features In Symptomatic Type I Chiari Malformation Patients

2018 ◽  
Vol 37 (03) ◽  
pp. 258-262
Author(s):  
Bruno Leimig ◽  
Claudio Vidal ◽  
Marcelo Valença ◽  
Joacil Silva ◽  
Walter Matias Filho
Keyword(s):  
Chiari Malformation ◽  
Cranial Nerves ◽  
Type I ◽  
Upper Limbs ◽  
Resonance Imaging ◽  
Tonsillar Ectopia ◽  
Occipital Headache ◽  
Magnetic Resonance Imaging Mri ◽  
Lower Cranial Nerves ◽  
T2 Mri

Objective Broader access to magnetic resonance imaging (MRI) has increased the diagnosis of tonsillar ectopia, with most of these patients being asymptomatic. The early diagnosis and treatment of type I Chiari malformation (CM I) patients has impact on the prognosis. This study supplements information about the neurologic exam of symptomatic patients with CM I. Methods The sample was composed of 32 symptomatic patients with CM I diagnosed by a combination of tonsil herniation of more than 5 mm below the magnum foramen (observed in the sagittal T2 MRI) and at least one of the following alterations: intractable occipital headache, ataxia, upper or lower motor neuron impairment, sensitivity deficits (superficial and deep) or lower cranial nerves disorders. Results Occipital headache was the most frequent symptom (53.12%). During the physical exam, the most common dysfunctions were those from the pyramidal system (96.87%), followed by posterior cord syndrome (87.5%). Discussion In this study, patients became symptomatic around the fifth decade of life, which is compatible with previous descriptions. Patients with more than 2 years of evolution have worse responses to treatment. Occipital headache, symptoms in the upper limbs, gait and proprioceptive disorders are common findings in patients with CM I. Conclusion Deep tendinous reflexes and proprioception disorders were the main neurologic features found in symptomatic CM I patients.

scholarly journals Midline Suboccipital Subtonsillar Approach with C1 Laminectomy for Resection of Foramen Magnum Meningioma: 2-Dimensional Operative Video

2019 ◽  
Vol 80 (S 04) ◽  
pp. S365-S367
Author(s):  
Stefan Lieber ◽  
Maximiliano Nunez ◽  
Rocio Evangelista-Zamora ◽  
Marcos Tatagiba
Keyword(s):  
Cranial Nerves ◽  
Inpatient Rehabilitation ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Proliferation Index ◽  
Surgical Approaches ◽  
Who Grade ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Lower Cranial Nerves

AbstractWe present a case of a medium-sized foramen magnum meningioma that was resected through a midline suboccipital subtonsillar approach with C1 laminectomy in prone (Concorde) position. The patient is a 77-year-old woman with a 6-month history of intermittent vertigo, moderate gait instability, and slight decline of memory.On magnetic resonance imaging (MRI) an extra-axial intradural lesion was discovered that originated from the right epicondylar region just inferior to the jugular tubercle and occupied the anterolateral aspect of the foramen magnum. There was moderate transposition and compression of the medulla at the level of the cerebellar tonsils.On physical examination the patient was ambulatory independently without motor weakness but exhibited some gait instability. The function of the lower cranial nerves was preserved.A gross-total resection was achieved, histopathology confirmed a WHO grade-I meningothelial meningioma with a low-proliferation index. The patient was discharged home 5 days after surgery, her gait instability improved significantly immediately after surgery and had resolved completely after 2 weeks of inpatient rehabilitation. There was no other neurological deficit. At 3-month follow-up MRI, there was no indication of meningioma residual or recurrence.In summary, the midline suboccipital subtonsillar approach is a powerful tool with limited morbidity in the armamentarium for the microsurgical management of a variety of pathologies residing in the posterior cranial fossa and the craniocervical junction. Oftentimes the space created by the pathology opens up corridors that can be exploited for microsurgical access to avoid more extensive surgical approaches.The link to the video can be found at: https://youtu.be/0uUxs13ze7w.

scholarly journals Far Lateral Craniotomy for Resection of Foramen Magnum Meningioma

2019 ◽  
Vol 80 (S 04) ◽  
pp. S355-S357
Author(s):  
Robert T. Wicks ◽  
Xiaochun Zhao ◽  
Celene B. Mulholland ◽  
Peter Nakaji
Keyword(s):  
Cranial Nerves ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Occipital Condyle ◽  
Formidable Challenge ◽  
Close Proximity ◽  
Vertebrobasilar Circulation ◽  
Far Lateral ◽  
Lower Cranial Nerves ◽  
Gain Access

Abstract Objective Foramen magnum meningiomas present a formidable challenge to resection due to frequent involvement of the lower cranial nerves and vertebrobasilar circulation. The video shows the use of a far lateral craniotomy to resect a foramen magnum meningioma. Design, Setting, and Participant A 49-year-old woman presented with neck pain and was found to have a large foramen magnum meningioma (Fig. 1A, B). Drilling of the posterior occipital condyle was required to gain access to the lateral aspect of the brain stem. The amount of occipital condyle resection varies by patient and pathology. Outcome/Result Maximal total resection of the tumor was achieved (Fig. 1B, C), and the patient was discharged on postoperative day 4 with no neurologic deficits. The technique for tumor microdissection (Fig. 2) is shown in the video. Conclusion Given the close proximity of foramen magnum meningiomas to vital structures at the craniocervical junction, surgical resection with careful microdissection and preservation of the overlying dura to prevent postoperative pseudomeningocele is necessary to successfully manage this pathology in those patients who are surgical candidates.The link to the video can be found at: https://youtu.be/Mds9N1x2zE0.

Ependymomas

2018 ◽  
Author(s):  
Paul Klimo ◽  
Nir Shimony
Keyword(s):  
Molecular Subtypes ◽  
Extent Of Resection ◽  
Postoperative Radiation ◽  
Resonance Imaging ◽  
Posterior Fossa Tumors ◽  
Total Resection ◽  
Cerebrospinal Fluid Diversion ◽  
Neural Axis ◽  
Magnetic Resonance Imaging Mri ◽  
Severe Hydrocephalus

Pediatric posterior fossa tumors are usually ependymoma, pilocytic astrocytoma, or medulloblastoma. Ependymoma appears well-demarcated with heterogeneous enhancement on magnetic resonance imaging (MRI). Full neural axis MRI is indicated to assess for metastatic disease. Management is typically surgical resection of the tumor, with consideration for cerebrospinal fluid diversion if patients present with severe hydrocephalus. Extent of resection of the tumor is the most important factor in predicting recurrence and overall survival, and gross total resection is ideal. Infratentorial ependymomas have 2 molecular subtypes, which has implications for responsiveness to adjuvant therapy and prognosis. Infratentorial ependymomas are biologically different from supratentorial ependymomas. Postoperative radiation improves local control.

scholarly journals Posterior fossa decompression with duraplasty in Chiari surgery: A technical note

2017 ◽  
Vol 63 (11) ◽  
pp. 946-949 ◽  
Author(s):  
Marcelo Ferreira Sabba ◽  
Beatriz Souza Renor ◽  
Enrico Ghizoni ◽  
Helder Tedeschi ◽  
Andrei Fernandes Joaquim
Keyword(s):  
Surgical Treatment ◽  
Posterior Fossa ◽  
Foramen Magnum ◽  
Technical Note ◽  
Posterior Fossa Decompression ◽  
State University ◽  
Resonance Imaging ◽  
Tonsillar Herniation ◽  
Craniocervical Instability ◽  
Magnetic Resonance Imaging Mri

Summary Chiari malformation (CM) is the most common and prevalent symptomatic congenital craniocervical malformation. Radiological diagnosis is established when the cerebellar tonsils are located 5 mm or more below the level of the foramen magnum on magnetic resonance imaging (MRI). Surgical treatment is indicated whenever there is symptomatic tonsillar herniation or syringomyelia/hydrocephalus. The main surgical treatment for CM without craniocervical instability (such as atlantoaxial luxation) is posterior fossa decompression, with or without duraplasty. The authors describe in details and in a stepwise fashion the surgical approach of patients with CM as performed at the State University of Campinas, emphasizing technical nuances for minimizing the risks of the procedure and potentially improving patient outcome.

scholarly journals Meningioma of Foramen Magnum Causing Drop Attacks

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Amit Mahore ◽  
Raghvendra Ramdasi ◽  
Sandip Mavani ◽  
Vithal Rangarajan ◽  
Manoj Patil ◽  
...  
Keyword(s):  
Foramen Magnum ◽  
Left Vertebral Artery ◽  
Loss Of Consciousness ◽  
Dramatic Improvement ◽  
Resonance Imaging ◽  
Drop Attacks ◽  
Frequent Episodes ◽  
Full Neurological Recovery ◽  
Magnetic Resonance Imaging Mri ◽  
The Brain

A 52-year-old female presented with frequent episodes of falls without loss of consciousness. These episodes lasted for brief period followed by full neurological recovery. Magnetic resonance imaging (MRI) of the brain showed foramen magnum meningioma encasing left vertebral artery. The patient had dramatic improvement after excision of the tumor.

scholarly journals Technical strategies to approach aneurysms of the vertebral and posterior inferior cerebellar arteries

2005 ◽  
Vol 19 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Niklaus Krayenbühl ◽  
Carlos A. Guerrero ◽  
Ali F. Krisht
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Foramen Magnum ◽  
Lateral Approach ◽  
Anatomical Location ◽  
Microsurgical Anatomy ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Pica Aneurysms ◽  
Lower Cranial Nerves

Object Aneurysms of the vertebral artery (VA) and proximal posterior inferior cerebellar artery (PICA) are rare and challenging lesions, as they are located in front of the brainstem and surrounded by the lower cranial nerves. Many different approaches have been described for their treatment, and have yielded different results. With the use of different examples of lesions, the authors describe their surgical strategy in the management of VA and PICA aneurysms. Methods The far-lateral approach was used, and the potential of its different extensions according to the specific anatomical location and configuration of different types of aneurysms is emphasized. Conclusions With the present knowledge of the microsurgical anatomy in the region of the foramen magnum, the far-lateral approach can be tailored to the specific anatomical and morphological configuration of an aneurysm in this region with good surgical results.

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