Anatomy and Tailored Surgical Approach to Foramina Magnum Meningioma

Foramen magnum meningiomas are described as tumors whose insertion zones are mainly situated in the foramen magnum region. The most commonly used approaches remain the posterior midline and far-lateral approaches. Transcondylar approach is not necessary in most cases and the anterior extended endoscopic endonasal approach seems promising, especially for small tumors with no vascular encasements and with a limited lateral and inferior extensions. Extensive tumor debulking and preservation of the arachnoid plane are the cornerstone for safe tumor mobilization and resection. Favorable surgical outcome can be achieved through adequate anatomical knowledge of the craniocervical junction, precise classification of the tumor, tailoring and selecting the best approach, applying the appropriate microsurgical technique, and judicious tumor resection with a focus on functional preservation surgery.