Surgery of Craniocervical Meningiomas

Objective: To study the different surgical approaches to craniocervical meningiomas in different locations in the area of the foramen magnum, whether anterior, posterior, antrolateral or posterolateral Methods: Twenty six patients with craniocervical meningiomas were operated upon during the period from 2000 to 2009 using the standard posterior approach for posterior lesions (14 cases), extreme lateral approach without drilling of the occipital condyle in the antrolateral and posterolateral lesions(6 cases) and transcondylar approach for anterior lesions (6 cases). Results: This study included 16 females and 10 males, the patients’ age ranged from 23 to 64 years with a mean of 51.8 years. Tumor size ranged from2 to 6.4 in its maximum diameter. Tumor location was posterior in 14 patients, lateral in 6 patients and anterior in 6 patients. Total tumor resection was done in 23 (88.4%) patients and subtotal in 3 (11.6%) patients. Postoperative complications included transient lower cranial nerves affection, transient hemiparesis. There was no mortality in this study. The follow up period ranged from 6 months to 4.8 years. Conclusion: Surgical approach to craniocervical meningioma has to be tailored according to the location of the tumor. Posterior tumors are safely totally removed through the slandered suboccipital approach. Posterolateral and antrolateral tumors are easily removed via the postero lateral retrocondylar approach without drilling of the occipital condyle benefiting from the working space given by lateral displacement of the brain stem. Anteriorly located tumors are better approached through the extreme lateral transcondylar approach to avoid brain stem retraction.