Few papers have been reported in literature on current management and prognosis of foramen magnum meningiomas. We present a homogeneous series of 28 cases operated on via the dorsolateral route in the semisitting position in the MRI-era. Being the dorsolateral route, a flexible approach, the extent of bone resection was tailored according to the individual case. Elderly patients (n = 11), sizable functional impairment (Karnofsky score < 70, n=21), large size of the tumors (mean diameter: 3.5 cm) and ventral or ventrolateral tumor position (n-26) characterized the case material. Total removal was achieved in all but two patients. No operative mortality occurred. The early outcome varied according to the type of preoperative dysfunction and to the surgical difficulties encountered. Whereas 95% of preoperative long tracts and cerebellar signs improved, only 15% of cranial nerves did so. Main complication was due to mild injury to the lower cranial nerves (n= 11). At final outcome (mean: 32 months), two-thirds of the cranial nerve deficits cleared and all but one patient came back to a normal life. It is concluded that microsurgical removal of ventral and ventrolateral foramen magnum meningiomas with this technique constitutes a safe arid recommended procedure.
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