Microsurgical treatment of tumors in the foramen magnum region

Objective To investigate the clinical features, surgical methods and techniques of tumors in the foramen magnum region. Methods Clinical data were analyzed using information from 20 patients who were admitted in Department of Neurosurgery, the Affiliated Hospital of Xuzhou Medical University from June 2011 to October 2018 and treated with microsurgery due to tumors in the foramen magnum region. It included 11 cases of meningioma, 4 cases of schwannoma, 2 cases of hemangioblastoma, 1 case of angiothelioma, 1 case of neurofibrosarcoma and 1 case of osteochondroma. According to the origin, main body and MRI results, the tumors were divided into three types: type I tumor which was mainly located behind the foramen magnum, including the basilar origin of the foramen magnum, a total of 10 cases; type II tumor which was mainly located in the side of the foramen magnum, a total of 6 cases; type III tumor which was mainly located in front of the foramen magnum, a total of 4 cases. Three surgical approaches were used for tumor removal: the suboccipital posterior median approach in 13 patients, the suboccipital retrosigmoid sinus approach in 4 patients, and the suboccipital far lateral approach in 3 patients. Results Total tumor resection was performed in 19 cases and major resection in 1 case. There were no reports of death during surgery. One patient underwent tracheotomy due to postoperative respiratory paralysis and died of pulmonary infection 1 month later. Clinical symptoms were improved in 14 cases. Preoperative symptoms were maintained in 3 cases. Postoperative symptoms were aggravated in 4 patients, including new neurological symptoms, limb movement disorder and respiratory paralysis. Conclusions The effect of microsurgical treatment of tumor in the foramen magnum region is satisfactory. It is essential to choose proper surgical approach according to preoperative position classification for safe and effective tumor resection.