Meningioma of the Cranio-cervical junction

Contributor:

Dr. Chris Ekong

Consultants:

Dr. Fred Gentili
Dr. Michael Schwartz
Dr. Renn Holness
Dr. Christopher Wallace
Dr. Mike Tymianski
Dr. Susan Brien

Case 14

Age: 73

Sex: Male

History: May 16, 2003. 6 month history of headaches and neck pain. Weakness in his arms and legs x 1 week. No bladder or bowel probl

Examination: Grade 4 + power in both arms and legs. Positive Rhomberg's sign. Hyperactive reflexes.

MRI of Brain and Cervical Spine showing an enhancing mass at the cranio-cervical junction anterior to the brainstem. Likely Meningiomas.

Now What?

1. Diagnosis?

2. Base of Skull surgery?

3. Stereotaxic Radiation?

To Brain Tumours Internet Rounds Group (May 20, 2003)

I have today seen a 73-year-old gentleman with what appears to be a meningioma at the cranio-cervical junction causing significant posterior displacement of the medulla and upper cervical spinal cord. I think it would be a good surgical case for a skull base Neurosurgeon. Your opinion would be greatly appreciated.

Chris

Dr. Fred Gentili, Neurosurgeon, Toronto - May 20, 2003

Dear Chris:

Thanks. This is a typical foramen magnum meningioma that would be best managed via a far lateral suboccipital approach with partial condylar resection without need for fusion.

Regards,

Fred

Dr. Renn Holness, Neurosurgeon, Halifax - May 20, 2003

Chris et all:

I agree concerning Fred's comments having handled several of these recently (the most recent almost identical to Case 14)

Note however

a) the long tail,

b) the ventral ,virtually bilateral situation of the lesion i.e. it may not be easy to get right across to the opposite side

For these reasons I doubt if a 'Class 1' excision will be achieved. However he is old enough for this not to matter in the long run.

Renn

Dr. Mike Tymianski, Neurosurgeon, Toronto - May 20, 2003

Hi Chris:

Nice case. With this degree of compression, would be inclined to offer the patient treatment unless medically unfit. If has sig. neuro deficit, would obviously expedite.

This tumor can be completely removed from a C1 laminectomy and a far-lateral suboccipital approach. I would do from either the left, or right side, depending on a higher resolution review of the axials. THe

verts/basilar are rarely encased. Would quote the patient a risk of lower cr n. palsies/temporary G-tube as the most common complication - in the order of 5-10%.

Best

Mike Tymianski

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