SURGICAL TREATMENT OF MENINGIOMA WITH VENTRAL AND VENTROLATERAL LOCALIZATION IN THE REGION OF THE FORAMEN MAGNUM

Meningiomas localized in the ventral part of the foramen magnum always represent a surgical challenge. Analysis was performed on the surgical approach to meningiomas with ventral localization in the craniocervical region in 6 patients. Two posterolateral surgical approaches were used, depending on whether the tumor was at the level of the foramen magnum or it transited into the cervical spinal canal. In the case of a tumor at the level of the foramen magnum, posterolateral approach was used, with the suboccipital bone removal, and removal of part of the occipital condyles, with the resection of the atlas arch and mobilization of a.vertbralis. In tumors propagated in the spinal canal, the same resection of the occipital bone and occipital condyle was done, with the removal of the atlas and part of the atlantoaxial joint. Due to destabilization, occipitocervical fixation was performed in the second posterolateral approach. The posterolateral approach with the suboccipital removal of the bones and the atlas or, if necessary, with the resection of the occipital condyle or atlantoaxial joint, enables a good ventral separation of the tumor attachment and subsequent gradual complete removal. Fixation is required in the event of a removal of the atlantoaxial joint or removal of more than half of the occipital condyle. Posterolateral approach is an absolute indication in all cases of the ventral and ventrolateral localization of meningiomas in the area of the cervico-occipital junction, because it provides complete visualization of the tumor and allows for its safe removal.