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PubMed1978

Cervical myelography with metrizamide (Amipaque). A comparison between conventional and computer-assisted myelography with special reference to the upper cervical and foramen magnum region.

Cervical myelography with metrizamide was performed in a series of 30 patients. Minor modifications to the conventional technique made it possible to carry out measurements of the sagittal diameter of the cord and to improve the opacification of the upper cervical--foramen magnum region. Computer tomography was performed with a head scanner within 1 h after the conventional examination, and the spinal cord surrounded by contrast medium was shown from C-3 to the foramen magnum region. Measurements of the sagittal diameter of the spinal canal and the cord at corresponding levels using the two methods showed good correlation.

Adolescent↗

PubMed1980

Normal and pathological growth of the foramen occipitale magnum shown in the plain radiography.

The transverse diameter fo the foramen occipitale magnum (f. o. m.) in the semiaxial skull X-ray was measured and evaluated statistically in 174 cerebrally healthy children of different ages. These normal values are contrasted with the foramen diameters of 35 children with verified Arnold-Chiari malformation as well as children with macrocephaly and microcephaly. The values in children with Arnold-Chiari malformation are all above the norm, irrespective of whether or not there is a concomitant hydrocephalus.

Adolescent↗

PubMed1986

Foramen magnum stenosis in homozygous achondroplasia.

A 4-month-old female with homozygous achondroplasia and daytime apnea was found to have a small foramen magnum by computerized tomography. Following suboccipital craniectomy and C1-C2 laminectomy respiratory problems did not recur during a 7 month post-operative period. We suggest that the respiratory problems in homozygous achondroplasia may be due to brainstem compression from an abnormally small foramen magnum.

Achondroplasia↗

PubMed1998

Transverse microincisions of the outer layer of the dura mater combined with foramen magnum decompression as treatment for syringomyelia with Chiari I malformation.

Numerous surgical procedures have been proposed for treatment of syringomyelia associated with Chiari I malformation, but the optimal treatment has not yet been uniformly standardised. The main aim of the surgical treatment of syringomyelia/Chiari I complex is directed toward restoration of physiological cerebrospinal fluid dynamic at the craniovertebral junction. We report the surgical results of eight patients, affected by syringomyelia and Chiari I malformation, age range from 18 to 62 years, treated by bony foramen magnum decompression combined with transverse microincisions of the outer layer of the dura mater. In an average postoperative follow-up period of two years neurological symptoms and signs improved in seven patients. Postoperative Magnetic Resonance showed a decrease in size of the syrinx in seven patients. These results suggest that foramen magnum decompression combined with transverse microincisions of the outer layer of the dura 1) is an effective and safe treatment option for syringomyelia and Chiari I malformation, 2) corrects the circulatory disturbances of cerebrospinal fluid dynamic, 3) leads to a decrease in size of the syrinx and to a significant improvement in neurological signs and symptoms, 4) avoids complications of intradural approaches and syringosubarachnoid shunting.

Adult↗

PubMed2004

Circumferential decompression of the foramen magnum for the treatment of syringomyelia associated with basilar invagination.

Posterior fossa decompression utilizing suboccipital craniectomy and duraplasty remains the standard surgical treatment for Chiari-associated syringomyelia. In the presence of basilar invagination, anterior decompression, typically transoral odontoidectomy, or posterior decompression may be performed. We report two cases in which anterior and posterior (circumferential) decompression of the foramen magnum was used to treat cervical syringomyelia successfully. These cases demonstrate that circumferential decompression of the foramen magnum may be necessary in some cases of cervical syringomyelia associated with basilar invagination and Chiari malformation.

Adult↗

PubMed2004

A simple technique for expansive suboccipital cranioplasty following foramen magnum decompression for the treatment of syringomyelia associated with Chiari I malformation.

The benefits of osteoplastic suboccipital craniotomies over the traditional suboccipital craniectomies have been recognized. We describe a simple method of expansive suboccipital cranioplastic craniotomy using a free bone flap and report satisfactory clinical results in 16 patients with syringomyelia associated with Chiari I malformation. A free suboccipital bone flap is created from the rostral part of the occiput by placing two to four burr holes and connecting them with a craniotome. The posterior bony margin of the foramen magnum and the posterior arch of C1 are removed thereafter. Then dural plasty using a patch graft of dural substitutes is performed. The expansive suboccipital cranioplasty is performed by positioning the free bone flap caudal to the original location and fixing it with titanium miniplates to construct a bony frame to cover the foramen magnum. The rostral part of the cranial defect is filled with bone chips created during the craniotomy. Sixteen patients underwent this procedure. There was no operative mortality and no major complication, such as persistent pseudomeningocele. Preoperative symptoms improved significantly in all patients except for one who had persistent dysesthetic pain. Our simple method of expansive suboccipital cranioplasty for the treatment of syringomyelia associated with Chiari I malformation proved useful and achieved satisfactory long-term results.

Adolescent↗

PubMed1988

Lateral approach to the anterior portion of the foramen magnum. Application to surgical removal of 14 benign tumors: technical note.

In surgery, better access to the anterior part of the foramen magnum with less risk to the lower brainstem can be obtained by lateral enlargement of the usual posterior opening. This requires exposure and control of the vertebral artery (VA) and the sigmoid sinus (SS) and, for further enlargement, medial transposition of the VA and section of the SS with inferior petrosal resection. This technique has been applied fully or partially in 14 cases of anteriorly located tumors of the foramen magnum. It widens exposure on the anterior aspect of the neural axis and allows work in a nearly frontal plane.

Adolescent↗

PubMed1994

Dural arteriovenous fistulae involving the transverse-sigmoid sinus and foramen magnum.

The authors present a rare case of dural arteriovenous fistulae (AVFs) involving both the transverse-sigmoid sinus and the foramen magnum, which was treated successfully with multi-staged endovascular procedures. The transverse-sigmoid sinus, which was thrombosed proximally and distally, was occluded by transarterial embolization followed by intraoperative embolization of the sinus using platinum coils. The dural AVF involving the foramen magnum was occluded via a transvenous approach.

Arteriovenous Fistula↗

PubMed2004

Experience of a single institution treating foramen magnum meningiomas.

Despite the introduction of skull base approaches, there is still controversy in the optimum surgical management of foramen magnum meningiomas. Between January 1990 and January 2003, 22 patients underwent 23 surgical procedures with a diagnosis of foramen magnum meningioma at Marmara University, Department of Neurosurgery. The suboccipital approach was used for 2 posteriorly located tumors with radiological total removal. The paramedian suboccipital approach was replaced by the far-lateral modification in the treatment of ventral meningiomas. 1 of the 20 ventral tumors was operated twice. The classical suboccipital approach was followed by the far-lateral modification. A gross-total removal was achieved in 21 patients. The overall morbidity was 32%. No specific and clinically significant complications attributable to the far-lateral modification were observed. The far-lateral approach has improved the success of surgery in ventrally located lesions. The posterior suboccipital approach is still indicated in the removal of lesions placed posterior to the dentate ligament.

Adult↗

PubMed2005

Microsurgical interruption of dural arteriovenous fistula at the foramen magnum.

We report two rare cases of progressive congestive myelopathy caused by dural arteriovenous fistulae (DAVF) at the foramen magnum. The first, a 69-year-old male with a 2-year history of progressive myelopathy, had symptoms unrecognized due to a past history that included spinal caries and congenital dislocation of the hip. The second, a 60-year-old male, had a recurrence of the myelopathy three months after endovascular occlusion of the DAVF feeding artery. Both patients were successfully treated by direct microsurgical interruption of the arterialized medullary vein with functional and radiological improvement. The clinical manifestations of DAVF at the foramen magnum are nonspecific, mimicking those of cervical spondylotic myelopathy or cervical neoplasm. Accurate and early diagnosis followed by complete obliteration of the fistula is mandatory to avoid permanent neurological deficit.

Aged↗

PubMedDate not supplied

Long-lasting improvement of arterial hypertension after surgical treatment of a foramen magnum meningioma: case report.

BACKGROUND: Neurogenic arterial hypertension has been proposed to be caused by neurovascular compression in many cases. However, there is little reference to tumors causing hypertension by local compression of the vagal nerve or the ventrolateral medulla oblongata. The following case illustrates the effects of surgery for a meningioma of the foramen magnum on arterial hypertension. CASE DESCRIPTION: A 54-year-old woman suffered from arterial hypertension for at least 7 months, for which she required a combined medical treatment regime. She suffered for 6 months from dizziness and tinnitus, more in the left ear than in the right. Neurologic examination revealed a horizontal fixation nystagmus and a mild left-sided hearing loss. Magnetic resonance imaging and computed tomographic angiography showed a contrast-enhancing tumor on the left side of the foramen magnum compressing the medulla oblongata close to the vertebral artery and vascularized by branches of the left PICA. Complete surgical extirpation was performed using a medial craniocervical approach. The tinnitus and dizziness were gone and hearing improved. Postoperatively, the arterial hypertension showed a long-lasting improvement (observation period 8 months) with only minimal medical treatment. CONCLUSION: Based on our case, we conclude that tumors in close proximity to the ventrolateral medulla oblongata may induce neurogenic hypertension, similar to neurovascular compression.

Cerebral Angiography↗

PubMed1990

Hoarseness as the sole presenting symptom of foramen magnum meningioma.

Foramen magnum tumours are rare. They may present with bizarre symptoms and mimic many conditions. We report a presentation with the sole complaint of hoarseness, never previously described in the literature. Voice returned to normal after surgical removal of the foramen magnum meningioma.

Aged↗

PubMed1996

Symptomatic subdural hygroma as a complication of foramen magnum decompression for hindbrain herniation (Arnold-Chiari deformity).

Pseudomeningocele is a well known complication of foramen magnum decompression. Symptomatic subdural hygroma has not previously been described. We discuss a case of Arnold Chiari malformation type 1 in a 55-year-old Caucasian woman who underwent foramen magnum and upper cervical decompression and who developed a symptomatic subdural hygroma 2 weeks following surgery. This complication was most likely due to a technical error during surgery. It responded favourably to conservative therapy.

Arachnoid↗

PubMed1990

An extreme lateral approach to intradural lesions of the cervical spine and foramen magnum.

Meningiomas and neurofibromas are the most common intradural extramedullary tumors of the foramen magnum and cervical spine. Many of these tumors are located ventral or ventrolateral to the spinal cord and medulla. Posterior approaches, although adequate for the management of most of these tumors, can sometimes result in incomplete removal of the tumor and exacerbation of the neurological deficits. Although the transoral and transcervical approaches provide a direct route to the tumor, the exposure of the lateral margins in the case of large tumors is inadequate. In addition, because of the removal of vertebral bodies, subsequent fusion may be necessary. In the present report, an extreme lateral approach to the foramen magnum and cervical spine for the removal of intradural tumors is described. The approach provides a lateral exposure of the tumor-cord/stem interface, thus permitting safe dissection without retraction of the cord. The entire longitudinal and lateral extent of the tumor and also its extradural extension can be can be managed by this approach. This approach can be considered in such a group of patients harboring entirely ventral or recurrent tumors for which the conventional posterior approach has failed. Six patients who underwent this procedure are described to illustrate its application.

Adolescent↗

PubMed1993

Cervical spondylotic myelopathy with occult foramen magnum meningioma--a case for MRI?

A fatal case of occult foramen magnum meningioma is described which presented with features of cervical myelopathy confirmed by cervical myelogram. Surgical decompression led to initial improvement followed by progressive deterioration and death. Postmortem examination revealed a 4 cm diameter foramen magnum meningioma. The dangers of using only standard radiographic investigations of the cervical cord are discussed.

Aged↗

PubMed1975

Radiological diagnosis of mass lesions within and adjacent to the foramen magnum.

Masses within or adjacent to the foramen magnum may present difficult clinical problems. They may sometimes be misdiagnosed as degenerative disease of the central nervous system, cervical spondylosis, or even cervical disk disease. In most cases, roentgenographyis necessary for proper diagnosis. The anatomy of the region of the foramen magnum is reviewed and 13 cases representing various diseases are presented. Alterations in the regional arterial and venous anatomy are emphasized.

Adult↗

PubMed1976

A simple myelographic maneuver for the detection of mass lesions at the foramen magnum.

Popular belief and teaching has emphasized the necessity for supine myelography to avoid missing lesions on the dorsal aspect of the foramen magnum; however, this required not only additional time but also considerable discomfort for the patient. A simple maneuver added to the prone myelogram, requiring little additional time and no discomfort, virtually assures the detection of lesions at or near the foramen magnum. This technique has been used in 40 patients suspected of having either a demyelinating process or a mass lesion involving the high cervical cord. Eight Chiari malformations and 1 meningioma were demonstrated.

Adolescent↗

PubMed1987

Study of the anatomic metric values of the foramen magnum and its relation to sex.

The sagittal and transverse diameters of the foramen magnum were examined in 100 human skulls (74 male, 26 female). The results were statistically analyzed and compared with those obtained by other authors. Our findings show that the sagittal and transverse diameters are clearly different, as well as the total area of the foramen magnum, these parameters being larger in male skulls than in female.

Adult↗