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Novel classification of foramen magnum meningiomas predicted by topographic position relative to neurovascular bundle

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Abstract

Purpose

Proximity to critical neurovascular structures can create significant obstacles during surgical resection of foramen magnum meningiomas (FMMs) to the detriment of treatment outcomes. We propose a new classification that defines the tumor’s relationship to neurovascular structures and assess correlation with postoperative outcomes.

Methods

In this retrospective review, 41 consecutive patients underwent primary resection of FMMs through a far lateral approach. Groups defined based on tumor-neurovascular bundle configuration included Type 1, bundle ventral to tumor; Type 2a-c, bundle superior, inferior, or splayed, respectively; Type 3, bundle dorsal; and Type 4, nerves and/or vertebral artery encased by tumor.

Results

The 41 patients (range 29–81 years old) had maximal tumor diameter averaging 30.1 mm (range 12.7–56 mm). Preoperatively, 17 (41%) patients had cranial nerve (CN) dysfunction, 12 (29%) had motor weakness and/or myelopathy, and 9 (22%) had sensory deficits. Tumor type was relevant to surgical outcomes: specifically, Type 4 demonstrated lower rates of gross total resection (65%) and worse immediate postoperative CN outcomes. Long-term findings showed Types 2, 3, and 4 demonstrated higher rates of permanent cranial neuropathy. Although patients with Type 4 tumors had overall higher ICU and hospital length of stay, there was no difference in tumor configuration and rates of postoperative complications or 30-day readmission.

Conclusion

The four main types of FMMs in this proposed classification reflected a gradual increase in surgical difficulty and worse outcomes. Further studies are warranted in larger cohorts to confirm its reliability in predicting postoperative outcomes and possibly directing management decisions.

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Fig. 1

© Glia Media, Artist: Tonya Hines, CMI

Fig. 2

© Glia Media, Artist: Tonya Hines, CMI

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

No code was used for the purposes of this research study.

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Acknowledgements

We are grateful to Mary Kemper for her guidance and expertise in preparation of this manuscript.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA

    Domenico A. Gattozzi, Omaditya Khanna, Patrick W. Hosokawa & A. Samy Youssef

  2. Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Ufuk Erginoglu & Mustafa K. Baskaya

  3. Department of Neurosurgery, Geisinger Commonwealth School of Medicine, Scranton, PA, USA

    Rafael Martinez-Perez

Authors
  1. Domenico A. Gattozzi
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  2. Ufuk Erginoglu
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  3. Omaditya Khanna
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  4. Patrick W. Hosokawa
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  6. Mustafa K. Baskaya
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  7. A. Samy Youssef
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Contributions

Conception and design: ASY, MKB.  Acquisition of data: DAG, UE, OK.  Analysis and interpretation of data: DAG, OK, MKB, ASY.  Drafting the article: DAG, OK, RMP, ASY.  Critically revising the article: DAG, RMP, OK, MKB, ASY.  Reviewed submitted version: DAG, OK, MKB, ASY.  Approved final version on behalf of authors: ASY, MKB.  Statistical analysis: PWH.  Study supervision: ASY.

Corresponding author

Correspondence to A. Samy Youssef.

Ethics declarations

Ethics approval

This is an observational study. The University of Colorado, University of Wisconsin-Madison, and Geisinger University Ethics Committees have confirmed that no ethical approval is required.

Consent to participate

Owing to the retrospective and de-identified nature of this research, informed consent was not necessary to be obtained, in line with requirements of our institutions’ IRBs. This study did not affect standard of care treatment for these patients and consent to participate is not applicable.

Consent for publication

This is a retrospective study of clinical outcomes and patient data is entirely de-identified when used for data analysis. As such, a consent for publication is not applicable.

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The authors have no relevant financial or non-financial interests to disclose.

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Gattozzi, D.A., Erginoglu, U., Khanna, O. et al. Novel classification of foramen magnum meningiomas predicted by topographic position relative to neurovascular bundle. Acta Neurochir 166, 199 (2024). https://doi.org/10.1007/s00701-024-06091-1

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