Why is meningioma's "difficult in the difficulty" Why is meningiomas in the foramen magnum of the occipital bone so dangerous? How to cut all safely and completely?

Walking weakness, neck pain, thought it was cervical spondylosis, but did not expect to find that after examination, it was meningioma, foramen magnum
.
In medicine, the tumor of the foramen magnum of the occipital bone is called the "difficult of the difficulty" in the meningioma of the base of the skull, and the operation of meningiomas in the foramen magnum area of the occipital bone is undoubtedly "dancing"
on the tip of the knife.

Why is meningioma in the foramen magnum of the occipital bone so dangerous?

Is there a possibility of safety and full cut?

As the world's master of the skull base

INC Professor Bartlangffy, Germany

And how to skillfully "defuse bombs",

Calmly cope with meningiomas in the foramen magnum?

Pictured: Professor Seeger, supervisor of Professor Bartlangffy at INC, hand-painted the foramen magnum area of the occipital bone

Meningiomas are mostly benign, so why is meningiomas in the foramen magnum of the occipital bone so dangerous?

Don't underestimate meningioma

It will make you hate it to the bone and difficult to live

These sufferings have a "cause"

Where there are dura maters in the skull

(The meninges envelop the entire brain and cranial nerves.
)

Drill through the wall to cover the entire skull)

All may be home to meningiomas

Meningiomas are mostly slow-growing, benign tumors

The probability of malignancy is small

It grows slowly and can be cured after full excision

However, the difficulty of meningioma treatment is that it is difficult to remove cleanly, and it is easy to recur, especially petroclinic meningioma, parasickle meningioma, and meningiomas in the foramen magnum of the occipital bone are the most difficult to resect, which has very high requirements for neurosurgeons, and the difficulty of surgical treatment is that the tumor occupies the key impulse, is difficult to reveal and is adjacent to the brainstem, can involve almost all cranial nerves, and is also closely
related to important blood vessels and perforations in the cerebral basin.

Foramen magnum maxiomaresection is one of the most challenging procedures because the base of the tumor is often located at the anterior edge of the foramen magnum and often involves important structures such as the medulla oblongata, vertebral artery, and posterior cranial nerve
.
Occipital foramen magnum are rare, accounting for 2.
5% of intracranial meningiomas and 4% of posterior fossa meningioma, of which 90% are located ventral or ventrolateral to
the brainstem.

The initial symptoms of patients with meningioma in the foramen magnum area of the occipital bone are not obvious, and most patients will have neck-occipital pain, neck movement or coughing and other strenuous movements can induce or aggravate symptoms, because of the similar symptoms to cervical spondylosis, many times will be misdiagnosed
.
Because the symptoms of occipital foramen meningioma are diverse, and most patients have heavier clinical manifestations when the tumor volume develops larger, it is often missed in the early stage
.

Foramen magnum maxiomaresection is one of the most challenging procedures because the base of the tumor is often located at the anterior edge of the foramen magnum and often involves important structures such as the medulla oblongata, vertebral artery, and posterior cranial nerve
.
To fully resect tumors, the surgeon has very high surgical skills, and requires the surgeon to have rich knowledge of neurosurgical anatomy, skilled surgical skills and skilled application
of modern high-precision medical equipment.

The founder of the far outer approach, INC Germany, Professor Bad Lanffy:

Surgical strategies for meningiomas in the foramen magnum region of the occipital bone

One of the members of the advisory group, the world master of skull base tumor surgery, and the chairman of the WFNS Education Committee of the World Federation of Neurosurgery Germany's Helmut Bertalanffy (Bartranffy, domestic patient called "Professor Ba") is very good at total surgery for difficult brain tumors such as meningiomas in the foramen magnum region of the occipital bone, and he has answered questions in detail for many difficult patients.
Provide safe surgical resection and postoperative treatment recommendations, and point out the follow-up treatment direction
for patients based on their condition, expectations and comprehensive conditions.

In his paper "Dorsolateral Approach to the Craniocervical Junction", Professor Bartlandfe deeply analyzed various lesions in the cranial and cervical junction, starting from the specific surgical case of the dorlateral approach of meningioma, focusing on the dorlateral approach of meningioma, in the greater occipital foramen area, and how to achieve safe total resection
.

Figure: Foramen magnum occipital area, the skull (a) and the right dorsolateral skull area (b)
are viewed from the right dorsolateral and inferior corners.
As indicated by the large arrow, the rectilinear view of the anterior edge of the foramen magnum and the anterior surface of the nerve axis are blocked
by the lateral border of the foramen magnum, the posterior condylar duct, and the medial portion of the atlanto-occipital joint.
By partially grinding the bone structure directly lateral to the dural entrance of the vertebral artery, the surgical angle can be sufficiently expanded to safely manipulate the anterolateral side of
the nerve axis.
OC: occipital condyle, JT: jugular vein nodule
.

Key points of meningioma treatment in the foramen magnum region of the occipital bone: the choice of surgical approach

The treatment of meningiomas in the foramen magnum region of the occipital bone is commonly used
surgically.
Considering that when the tumor is small, the surgical operation space is relatively small, and the neurological complications after surgery in this area are often more serious, for some asymptomatic or elderly patients with mild symptoms, some scholars recommend conservative observation or radiotherapy
with gamma knife or cyberknife.

The choice of surgical method has been the focus of long-term debate among neurosurgeons, the most commonly used clinical approach is the distal lateral approach and the posterior occipital median approach, according to the classification of the tumor, the tumor located on the dorsal side is usually selected posterior median approach, located in front of the medulla oblongata or lateral tumor, the more commonly accepted is the use of the far lateral approach, in recent years, scholars have proposed that the use of the post-median approach can also be safe and effective for the resection
of ventral and lateral occipital foramen meningioma.
The choice of surgical approach depends on the classification of the tumor, and the clinical classification of the tumor is often mainly based on the location of the tumor and the relationship with the vertebral artery
.

More than 30 years ago, Bartranfi and his supervisor Professor Seeger published a number of papers, proposed to smooth the "occipital condyle", pointed out the key, operational difficulty and technology of the far-lateral approach, and played a decisive role in the improvement and development of the far-lateral approach, and is an important pioneer and pioneer of
the far-lateral approach 。 This Bertalanffy version of the transoccipital condyle distal-lateral approach is still documented almost unchanged in the 6th edition of the classic surgical treatise " Schmidek Surgery "
.

Bertalanffy and his mentor Seeger (1991) proposed the "dorsolateral, suboccipital, transcondylar approach" approach

INC German Professor Bartlangfi Professor Occipital foramen area meningioma successful case description

Safe and complete resection is the premise to ensure a good prognosis of meningioma, and Professor Ba has answered questions for many difficult patients in detail, provided safe surgical resection and postoperative treatment suggestions, and pointed out the follow-up treatment direction
for patients based on their condition, expectations and comprehensive conditions.
The following is a sharing of some successful cases of Professor Ba's surgery in the foramen magnum area, let's see if their tumors are safe and fully excised? How is the recovery after surgery?

Successful case sharing of meningiomama in the foramen magnum of the occipital bone

Condition review: Belle, who is in her 50s, has been suffering from neck pain for more than a year, and she always thought she had cervical spondylosis, but her neck massage and acupuncture treatment did not improve
.
Unfortunately, one night, she began to have difficulty walking, unable to lift her feet, and almost fell to the ground.

However, due to the deep location of the lesion, adjacent to the brainstem, cervical medulla, vertebral artery, posterior cranial nerve and other important tissues, blood vessels, nerve structures, is the center of life, blood supply is very rich, preoperative may cause respiratory heartbeat arrest, any small blunder may make the patient either dead or disabled
.

Treatment process: At the recommendation of patients, she found Professor Bartlangffy, a member of WANG, member of the INC World Neurosurgery Advisory Group and the president of the World Federation of Neurosurgery WFNS, and learned that she could arrange admission for her safe total surgery
at any time after consulting Professor Ba remotely.

During the operation, Professor Ba took the left decubitus dislateral approach to completely resect the tumor, and carefully protected
the brainstem and spinal cord during the operation.

Intraoperative and intradural location after tumor resection

The surgical incision and the patient's position at the time of the procedure

Postoperative CT and MR showed that both the tumor and its bone invaded by the tumor were removed, the tumor was completely resected, and the Simpson was resected
in the first degree.

Belle had no new-onset neurological deficit after surgery and began limb activity and rehabilitation
the day after surgery.
Although there is still mild neck pain, it has improved and disappeared after the recovery period, and there are no serious surgical complications and no sequelae that will affect the quality of life in the future, especially if there is no cerebrospinal fluid leakage or spinal instability
during the operation.
Imaging studies show that the tumor has been completely resected, the postoperative wound heals well, and no need for chemoradiotherapy
.

Professor Ba shared a wonderful case of meningioma in the foramen magnum region of the occipital bone

Case 1:

46-year-old woman, gait disorder, sensory impairment, good postoperative condition, no neurological impairment
.

Case 2:

75-year-old woman with ataxia and neck pain
.
After a safe total excision, the imbalance disappears, there is no neurological impairment, and life returns to normal
.

Case 3:

33-year-old woman with severe neck pain and paresthesia
on the right side of her body.
Safe total resection, no recurrence after 6 years after surgery, good
condition.
No neurological impairment
.

Case 4:

51-year-old woman with vertigo, mild hypoglossal
nerve dysfunction.
After a safe total excision, the dysfunction of the hypoglossal nerve disappears
.

Case 5:

54-year-old man with neck pain, ataxia, dysphagia, and hypoglossal nerve palsy
.
After a safe full cut, the symptoms disappear and the state is good
.
No neurological impairment
.

Case 6:

A 53-year-old man with sluggish sensation in his arms and face
.
After a safe full section, motor function is restored without injury
.

Case 7:

65-year-old man with gait ataxia and dysphagia
.
The operation was safe and complete, in good condition, and there was no neurological damage
.

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