대후두공의 앞쪽에 발생한 뇌수막종에 대한 수술

Abstract

Objective: The surgical approach to foramen magnum meningioma is crucial to get a radical removal. The standard surgical technique is based in far lateral suboccipital approach. In this paper the authors present a surgical series of foramen magnum meningioma, which were removed with a technique based in the removal of tumor from the posterior skull base without low cranial nerve injury.

Methods : From March 2001 to February 2006, 12 patients with a foramen magnum meningioma were operated. The far lateral extension of the classic suboccipital craniectomy has been found to reduce the depth of the field and improve the angle of surgical perspective to the ventrolateral clivus. The surgical techniques proposed were based in the exposure of anterior aspect of brainstem. The suboccipital craniectomy and partial condylectomy were performed exposing the jugular bulb, sigmoid. The tumor was removed as piecemeal fashion with the help of suction and coagulation. The anterior border of the tumor was removed using a dissection under the low cranial nerve. The dura of the posterior fossa was opened and an intradural tumor removed. After removal, the dura was closed and the defect occluded with tachocomb.

Results : We removed the mass by partial condylectomy via far lateral transcondylar approach without neurological deficit and postoperative craniovertebral instability.

Conclusion : If a lesion may be approached through a perpendicular exposure, the suboccipital craniectomy alone may be sufficient, especially ventral foramen magnum meningioma. Additional exposure of the ventrolateral clivus without brainstem retraction requires condylar removal.