Foramen magnum meningiomas: Surgical approaches and outcomes from a single-center series

Background: Foramen magnum meningiomas (FMMs) are rare skull base tumors whose surgical management is challenging due to their relationship with the brainstem, lower cranial nerves, and vertebral arteries.

Methods: We retrospectively analyzed 14 patients who underwent microsurgical resection of FMMs between 2014 and 2024. Data included demographics, tumor location, surgical approach, extent of resection, complications, and functional outcomes.

Results: The mean age was 51 years (range 29-82), with a female predominance (9/14). Tumors were anterior (15%), anterolateral (35%), lateral (35%), and posterior (15%). All patients were operated in the prone position, with a posterolateral suboccipital approach in four cases (28.5%). Gross total resection (Simpson III) was achieved in 85%. Complications included transient cranial nerve deficits (14%) and cerebrospinal fluid fistula (14%). No permanent deficits occurred. One patient (7.1%) died of postoperative complications. Mean Karnofsky Performance Score improved from 75 preoperatively to 90 at last follow-up.

Conclusion: Tailored microsurgical approaches, guided by dural attachment and neurovascular configuration, enable safe and effective resection of FMMs with high rates of tumor control and favorable functional outcomes.