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PubMed2003

Dorsal foramenal extraosseous epidural cavernous hemangioma.

Cavernous hemangiomas are vascular hamartomatous malformations that affect the central nervous system. This pathology is frequently encountered in the cerebral hemispheres, cerebellum, and brainstem. Cavernous hemangiomas infrequently occur at the spinal level or relative to an intramedullary localization; extramedullary epidural sites are also sometimes affected by this pathology. We report an extradural, extramedullary, cavernous hemangioma with foramenal extension of the dorsal section and discuss the differential diagnosis with dorsal foramenal neurinoma. A 52-year-old woman was admitted with irritation and deficit symptoms radiating into the left D3 spinal root space. The first radiological diagnosis was of a foramenal neurinoma beginning at the D3 root. The presence of a heterogeneous MR signal in both T1 and T2 images led us to consider the differential diagnosis of a cavernous hemangioma lesion. The patient underwent microsurgical treatment with a far lateral extraforamenal approach. Symptoms quickly improved: pain and dysesthesia disappeared after surgery and only light hypoesthesia was found. We want to stress the importance of MR imaging in formulating a correct differential diagnosis with foramenal neurinoma and underline that microsurgical treatment with a far lateral extraforamenal approach allowed us to remove the lesion completely without affecting Denis's posterior column, the lamina, and the articular facet.

Diagnosis, Differential↗

PubMed1996

Clinical utility of magnetic corticospinal tract stimulation at the foramen magnum level.

We applied magnetic stimulation of the corticospinal tract at the foramen magnum level to 19 patients with various neurological disorders. Results were consistent with our previous speculation that activation occurs at the foramen magnum level. This method was clinically useful for the following conditions. (1) Detection of subclinical lesion: one patient who had transient ischemic attack that caused no clinical symptoms at examination was shown to have dysfunction of the corticospinal tract. (2) Multiple lesions: our method disclosed at least one lesion above and below the foramen magnum in two patients with multiple sclerosis. (3) Unmasking of dysfunction of the corticospinal tract masked by peripheral neuropathy: magnetic stimulation showed conduction delay in the corticospinal tract in two patients in whom no pyramidal signs were evident because of muscular atrophy due to neuropathy. One patient had multiple sclerosis and chronic inflammatory demyelinating polyradiculoneuropathy, the other had degenerative ataxia and neuropathy. (4) Association of disorders: conduction delay rostral to the foramen magnum, which should not occur in patients with only cervical myelopathy, was shown in a patient with cervical myeloradiculopathy and amyotrophic lateral sclerosis. We conclude that this magnetic stimulation method which is less painful than electrical stimulation has extensive clinical usefulness.

Adult↗

PubMed1975

Simple determination of the foramen in trigeminus coagulation.

The object is to achieve a high degree of precision in the determination of the foramen ovale in managing trigeminus neuralgia stereotactically as well as by free-hand penetrations. We carried out exact measurements on lateral skull x-rays of 55 corpses and 25 patients. With the aid of a design and several plain x-ray films we drew connecting-lines between fixed, easily determined points of the skull. The middle of the foramen ovale coincides with the dissecting point of these 3 co-ordinates, the maximal deviation of 2 mm is clinically negligible compared with the total width of the foramen. The average distance of the foramen from the midline as measured on the basic projection is 2.8 cm +/- 2 mm. The puncture technique and the thermocontrolled coagulation of the trigeminus branches are discussed.

Foramen Magnum↗

PubMed2001

Surgery on anterior foramen magnum meningiomas using a conventional posterior suboccipital approach: a report on an experience with 17 cases.

OBJECTIVE: The advantages of a posterior "conventional" suboccipital approach with a midline incision over lateral, anterolateral, and anterior approaches to anteriorly placed foramen magnum meningiomas are discussed. METHODS: From 1991 to March 2000, 17 patients with foramen magnum meningiomas arising from the anterior or anterolateral rim of the foramen magnum underwent operations in the Department of Neurosurgery at King Edward Memorial Hospital and Seth G.S. Medical College. All patients were operated on in a semi-sitting position by use of a conventional suboccipital approach with a midline incision and extension of the craniectomy laterally toward the side of the tumor up to the occipital condyle. RESULTS: The patients ranged in age from 17 to 72 years, and the tumors ranged in size from 2.1 to 3.8 cm. The intradural vertebral artery was at least partially encased on one side in eight patients and on both sides in two patients. The brainstem was displaced predominantly posteriorly in each patient. A partial condylar resection was performed in two cases to enhance the exposure. Total tumor resection was achieved in 14 patients, and a subtotal resection of the tumor was performed in the other 3 patients. In one patient, a small part of the tumor was missed inadvertently, and in the other two patients, part of the tumor in relation to the vertebral artery and posterior inferior cerebellar artery was deliberately left behind. After surgery, one patient developed exaggerated lower cranial nerve weakness. There was no significant postoperative complication in the remainder of the patients, and their conditions improved after surgery. The average length of follow-up is 43 months, and there has been no recurrence of the tumor or growth of the residual tumor. CONCLUSION: From our experience, we conclude that a large majority of anterior foramen magnum meningiomas can be excised with a lateral suboccipital approach and meticulous microsurgical techniques.

Adolescent↗

PubMed1984

Benign tumors of the foramen magnum.

The authors reviewed 102 documented cases of benign extramedullary tumors of the foramen magnum treated at their institution between 1924 and 1982. There was 78 meningiomas, 23 neurofibromas, and one teratoma. Approximately 40% of the patients had a normal neurological examination upon first evaluation. The most frequent presenting complaints were suboccipital neck pain, dysesthesias, gait disturbances, weakness, and hand clumsiness. The average time from initial symptoms to diagnosis was 2 1/4 years. The most common findings included hyperreflexia, arm or hand weakness, Babinski sign, spastic gait, sensory loss, and 11th cranial nerve involvement. Based on these cases, an attempt is made to distinguish foramen magnum tumors from other disease entities by a grouping of signs and symptoms. There is no clinical finding that is pathognomonic. Metrizamide computerized tomography scanning and Pantopaque myelography have been the radiographic tests most commonly used to evaluate the foramen magnum. Recent experience suggests that nuclear magnetic resonance scanning will be a very useful noninvasive means of evaluating the foramen magnum region.

Adolescent↗

PubMed2004

Foramen magnum cerebrospinal fluid flow characteristics in children with Chiari I malformation before and after craniocervical decompression.

OBJECT: The Chiari I malformation presents significant challenges to clinicians because its pathophysiology is not well understood. In conducting cerebrospinal fluid (CSF) flow studies, investigators have attempted to correlate the clinical severity of these lesions with general flow velocity or bulk flow at the foramen magnum; however, these techniques have not allowed consistent prediction of symptomatology, explanation of the presence of syringomyelia, or the assessment of the hydrodynamic characteristics of the decompression. The authors used temporally and spatially resolved flow analyses to assess the characteristics of CSF flow in children with Chiari I malformation and the changes in these flow characteristics that occur after suboccipital decompression. METHODS: The authors studied eight children with symptomatic Chiari I malformation with or without syringomyelia and two children without Chiari I malformation. All patients underwent phase-contrast magnetic resonance imaging before and after posterior fossa decompression. Velocity plots were displayed for each voxel. Several indices of CSF flow were developed to characterize the flow patterns associated with Chiari I malformation. In children with symptomatic Chiari I malformation, even though bulk flow or velocity is often normal, there was marked heterogeneity of flow at the foramen magnum. This was evident for several reasons: 1) an increase in cephalad and caudad peak velocities; 2) spatial inhomogeneity in velocities; 3) simultaneous bidirectional flow; and 4) substantial net craniad or caudad flows within particular voxels and subregions during the cardiac cycle. After posterior fossa decompression, the severity of these flow abnormalities decreased. CONCLUSIONS: Foramen magnum CSF flow in children with symptomatic Chiari I malformations is spatially and temporally heterogeneous, and this heterogeneity improves postoperatively. The authors propose that relying on mean flow parameters in patients with Chiari I malformation is no longer sufficient; instead, more elaborate techniques to analyze foramen magnum CSF flow have become necessary.

Adolescent↗

PubMed1986

A morphological comparison of the foramen magnum of the male Middle Kyushuites with that of other ethnological groups.

The foramen magnum of the male Middle Kyushuites was examined by both osteoscopic and osteometric methods. In the osteoscopic study, the two-semicircular shape was the most numerous as in the case of the adult Germans. The breadth and the index of the foramen magnum did not show any significant differences between the male Middle Kyushuites and the other ethnological groups, while the length of the foramen magnum was shorter than that of the others with a statistical significance. The mean length of the foramen magnum of the Kikai-islanders was the longest among the Japanese.

Adult↗

PubMed1975

[Meningioma of foramen magnum--report of two dases and review of reference: its clinical manifestations (author's transl)].

Two cases of the spinocranial type of meningioma of the foramen magnum are presented with review of references, its clinical manifestations and surgical consideration. The clinical syndrome is stereotyped, but the patients with occipital or cervical pain, stiff neck, muscle weakness of the upper and lower limbs and disturbance of gait, which may be called "Foramen Magnum Syndrome", should always be suspected of having a mass lesion in the upper cervical or foramen magnum. Myelography is of prime importance in confirming the diagnosis and when preformed with care and understanding of the anatomy without fearing of losing the contrast material into the basilar cisterns, the myelographic examination is not difficult. We also stress the importance of preoperative vertebral angiographic study as well as myelographic study, because of the initimate relationship of the meningioma of the foramen magnum with the vertebral artery.

Adult↗

PubMed2003

Foramen magnum tumors: a series of 30 cases.

BACKGROUND AND AIMS: Foramen magnum tumors, especially those located ventrally, are surgically challenging. We studied clinical and surgical details of extramedullary tumors located in the region of the foramen magnum. MATERIAL AND METHODS: A series of 30 cases of extramedullary tumors at the foramen magnum, operated over a period of 8 years is presented. RESULTS: There were 10 neurofibromas, 8 meningiomas, 6 chordomas, 2 tuberculomas and 4 miscellaneous tumors. The clinical profile consisted of sensory symptoms in all the patients, quadriparesis in 24, lower cranial nerve affection in 8 and sphincter disturbances in 6 patients. The surgical approaches consisted of an extreme lateral approach in 10, a posterior or posterolateral approach in 18 and a per-oral route in 2 cases. Total excision of the tumor was performed in 24 and a subtotal excision of the tumor was done in 6 cases. Two patients died, one due to meningitis and the other due to chest infection. Eight other patients had complications like CSF leak, meningitis, pseudomeningocele, laryngeal edema, and transient worsening of neurological deficits. CONCLUSIONS: Foramen magnum tumors have long been regarded as difficult lesions both in terms of diagnosis and management. However, with the availability of MR imaging, newer surgical techniques and skull basal exposures, the excision of these lesions is becoming easier and safer.

Adolescent↗

PubMed2005

An anatomical study of the pterygoalar bar and the pterygoalar foramen.

The paper presents anatomical considerations on the pterygoalar bar and the pterygoalar foramen of the human skull. The pterygoalar bar is a bony bridge that stretches between the lateral pterygoid lamina and the greater wing of the sphenoid bone, while the space under this bar is termed the pterygoalar foramen. These structures were noted in 5 out of 70 investigated skulls. The length of the pterygoalar bar ranged from 4 to 8 mm, while the diameter of the pterygoalar foramen ranged from 7 to 11 mm. The presence of the pterygoalar bar is clinically important because it may disturb access to the foramen ovale during anaesthesia of the trigeminal nerve.

Foramen Magnum↗

PubMed1986

[Foramen magnum tumor--the diagnosis and surgical approach].

The seven cases of the foramen magnum tumors were presented with the clinical manifestations and surgical consideration. Early clinical symptoms of the cases with extramedullary lesions were suboccipital neck pain followed by dysesthesia, clumsiness of hand and weakness. On the other hand, early symptoms of the cases with intramedullary lesions were dysesthesia, often followed by swallowing difficulty or hoarsness, which may have some difference from the clinical course of the extramedullary tumor cases. CT scan was remarkably useful in the diagnosis of the foramen magnum tumor. Surgical treatment was done to 6 cases: Five of these cases were operated by suboccipital craniectomy, and one case with an anteriorly located meningioma in the foramen magnum region was operated by transoral approach. Total removal could be performed in the case without damage to the medulla or spinal cord. The surgical treatment was reviewed, and the approach appropriate to tumor location around the foramen magnum should be selected.

Adolescent↗

PubMed1980

[An operated case of foramen magnum neurinoma (author's transl)].

A 36-year-old male with craniospinal type of foramen magnum neurinoma removed totally was reported. Foramen magnum neurinoma shows various clinical symptoms called foramen magnum syndrome but none of them is specific. Therefore almost all the cases in the literature have been misdiagnosed as degenerative or demyelinating diseases. The best way for correct diagnosis is to suspect the existence of the tumor. Conventional suboccipital craniectomy has been adopted to remove the tumors. But craniospinal type of this tumor usually develops in the anterior part of the foramen magnum. Therefore we approached to the tumor from aside in the lateral position. In this approach, we can avoid tissue damage of cerebellum and medulla due to retraction and can reach near the midportion of the posterior fossa. The importance of checking respiration during surgery is also emphasized, because surgical intervention is carried out around the medulla oblongata.

Adult↗

PubMed1995

[A case of a young infant with Chiari II malformation treated by only bony foramen magnum decompression].

A case of a young infant with Chiari II malformation treated by only foramen magnum decompression was reported. The patient was a 3-month-old infant with a one-month history of stridor and respiratory distress. The myelomeningocele was surgically repaired. At the age of two weeks, a ventriculoperitoneal shunt had been inserted. On admission, MRI demonstrated Chiari II malformation. The shunt mechanism was functioning. Suboccipital craniectomy and upper cervical laminectomy from C1 to C5 level was performed. After the removal of the dural band at the foramen magnum level, good pulsation of the dura mater was demonstrated. After surgery, the stridor and respiratory distress disappeared. Foramen magnum decompression carried out by our surgical technique is advantageous because all the procedures are extradural and there are, therefore, fewer postoperative complications than the foramen magnum decompression techniques previously reported.

Arnold-Chiari Malformation↗

PubMed1997

[A case of foramen magnum meningioma in which case enhanced three-dimensional CT scan was valuable for preoperative evaluation of the surgical approach].

We report a case of foramen magnum meningioma in which case enhanced three-dimensional CT scan was valuable for preoperative evaluation of the surgical approach. A 53-year-old woman had suffered from stiffness and pain in the left occipital region and numbness of the left side of the face for about 2 years before admission. She had also weakness and numbness of the left side of her body for about 2 months before admission, and dysphagia and pain in the occipital region and in the posterior region of the neck produced by straining for about 1 month before admission. Neurological examination revealed left hemiparesis, and hypalgesia and tactile hypesthesia of the left side of the body, including the face. Plain X-P was normal. Enhanced CT scan and gadolinium enhanced MRI revealed a well-enhanced mass attached to the left anterolateral part of the foramen magnum. The left occipital condyle was observed at the lateral side of the attachment part of this mass. Angiography revealed tumor feeders from the meningeal branches of the left vertebral artery and the left ascending pharyngeal artery. Enhanced three-dimensional CT scan clearly showed that the tumor was attached to the left anterolateral part of the foramen magnum, that the left occipital condyle was at the lateral side of the attachment part of this mass and that the jugular foramen and jugular tubercle were situated superolateral to the attachment part of this mass. Considering these factors, we decided that removal of the posterior part of the left occipital condyle was necessary, but removal of the left jugular tubercle was not necessary for a good operative view from the left posterior lateral direction. The tumor was totally removed successfully and good results were obtained by the transcondylar approach without removal of the jugular tubercle. Histology of the tumor revealed meningothelial meningioma. In this case, preoperative evaluation with enhanced three-dimensional CT scan was helpful for deciding the surgical approach. With enhanced three-dimensional CT scan, it is easy to judge whether removal of the posterior part of the occipital condyle and/or the jugular tubercle is necessary for a good operative view, and we can get good images revealing the relationships between the tumor and surrounding structures. Preoperative evaluation with enhanced three-dimensional CT scan is very useful especially in this kind of situation.

Female↗

PubMed1997

Patent foramen ovale in patients with cerebral infarction. A transesophageal echocardiographic study.

OBJECTIVES: To determine the frequency of patent foramen ovale (PFO) among various subtypes of cerebral infarction. To determine whether any historical or clinical characteristics predict the presence or absence of PFO in these patients. DESIGN: Comorbidity and infarct subtype study. SETTING: Referral-based study. PATIENTS: One hundred sixteen patients with cerebral infarction consecutively referred for transesophageal echocardiography during a 6-month period. MAIN OUTCOME MEASURES: Infarct subtype classification was made using a clinical and radiographic diagnostic rubric similar to that used by the Stroke Data Bank of the National Institute of Neurological Diseases and Stroke. The frequency of various risk factors and clinical characteristics in patients with and in those without PFO and the frequency of PFO in patients with various infarct subtypes were compared (chi 2 or Fisher exact tests). RESULTS: Patent foramen ovale was detected in 37 patients (32%). Mean age was similar in those with (60 years) and those without (64 years) PFO. Patent foramen ovale was more frequent among men (39%) than women (20%, P = .03). Patients with PFO had a lower frequency of atrial fibrillation, diabetes mellitus, hypertension, and peripheral vascular disease compared with those without PFO. There was no difference in frequency of the following characteristics in patients with PFO compared with those without PFO: pulmonary embolus, chronic obstructive pulmonary disease, pulmonary hypertension, peripheral embolism, prior cerebral infarction, nosocomial cerebral infarction, Valsalva maneuver at the same time of cerebral infarction, recent surgery, or hemorrhagic transformation of cerebral infarction. Patent foramen ovale was found in 22 (40%) of 55 patients with infarcts of uncertain cause and in 15 (25%) of 61 with infarcts of known cause (cardioembolic, 21%; large vessel atherostenosis, 25%; lacune, 40%) (P = .08). When the analysis was restricted to patients who underwent Valsalva maneuver, PFO with right to left or bidirectional shunt was found in 19 (50%) of 38 patients with infarcts of uncertain cause and in 6 (20%) of 30 with infarcts of known cause (P = .01). CONCLUSION: Although PFO was overrepresented in patients with infarcts of uncertain in our and other studies, it has a high frequency among patients with cerebral infarction of all types. The relation between PFO and stroke requires further study.

Aged↗

PubMed1999

Direct visualization of blood flow through the interaortic foramen of the eastern diamondback rattlesnake, Crotalus adamanteus, using echocardiography and color Doppler imaging.

The bases of the left and right aortae in snakes are joined by the interaortic foramen. Previous anatomical and physiological studies have raised the possibility of blood flow through this foramen playing an important role in the redistribution of blood throughout the body, particularly during periods of hemostatic stress. Echocardiography was employed to view the heart of unanesthetized specimens of the eastern diamondback rattlesnake, Crotalus adamanteus. The echocardiographic images, and particularly the color Doppler imaging, revealed that the patency of the interaortic foramen changes during the cardiac cycle, and that blood regularly flowed through the interaortic foramen between the two aortae. J. Exp. Zool. 284:742-745, 1999. Copyright 1999 Wiley-Liss, Inc.

Journal Article↗

PubMed1990

Mylohyoid and jugular foramen bridging in pre-Columbian Chileans.

The occurrence of mylohyoid groove bridging and jugular foramen bridging was determined in a population of adult Pre-Columbian Chileans. Two hundred forty-one crania (110 males, 131 females) were examined for jugular foramen bridging and 464 mandibles (252 males and 212 females) were observed for mylohyoid groove bridging. The overall incidence of jugular foramen bridging was 14.94%, with females showing a higher occurrence (18.32%) than males (10.91%); however, no statistical significance was found between the sexes. The right side showed a greater incidence than the left, but again no statistical difference was noted and the occurrence of this trait was found to be associated between the sides. This frequency of jugular foramen bridging is higher than that found in other studies and approaches that reported in North American Eskimo populations. In the case of mylohyoid groove bridging, the incidence was 4.09% with no difference found between the sexes. This frequency of occurrence is less than the values reported previously for the other American populations of Mongoloid ancestry including the Pre-Columbian Peruvian population. The importance of nonmetric skeletal traits for defining population groups and their usefulness as anthropological tools is discussed. It is concluded that hard tissue variations such as bony bridging may be reliable markers to aid in discretely identifying population groups, but their importance can be significantly enhanced by coupling as many traits as possible in future studies.

Asian People↗

PubMed1976

Cine angiographic diagnosis of patent foramen ovale in paradoxical embolism,.

A case of paradoxical embolism is presented in which the antemortem diagnosis was facilitated by a new simple angiographic technique that demonstrated a patent foramen ovale. An additional 14 patients were studied by this technique, and one had a patent foramen ovale. The mechanism of reversal of the normal intraatrial pressure gradient and subsequent right to left shunt through a patent foramen ovale is discussed. This angiographic technique may be readily applied in any diagnostic catheterization laboratory and complements existing methods for detecting patency of the foramen ovale in patients with suspected paradoxidal embolism.

Adult↗