Benign tumors of the foramen magnum

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✓ The authors reviewed 102 documented cases of benign extramedullary tumors of the foramen magnum treated at their institution between 1924 and 1982. There was 78 meningiomas, 23 neurofibromas, and one teratoma. Approximately 40% of the patients had a normal neurological examination upon first evaluation. The most frequent presenting complaints were suboccipital neck pain, dysesthesias, gait disturbances, weakness, and hand clumsiness. The average time from initial symptoms to diagnosis was 2¼ years. The most common findings included hyperreflexia, arm or hand weakness, Babinski sign, spastic gait, sensory loss, and 11th cranial nerve involvement. Based on these cases, an attempt is made to distinguish foramen magnum tumors from other disease entities by a grouping of signs and symptoms. There is no clinical finding that is pathognomonic. Metrizamide computerized tomography scanning and Pantopaque myelography have been the radiographic tests most commonly used to evaluate the foramen magnum. Recent experience suggests that nuclear magnetic resonance scanning will be a very useful noninvasive means of evaluating the foramen magnum region.

Article Information

Address reprint requests to: Michael J. Ebersold, M.D., Department of Neurosurgery, Mayo Clinic and Foundation, Rochester, Minnesota 55905.

© AANS, except where prohibited by US copyright law.

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Figures

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    Pantopaque myelograms. Left: Supine view demonstrating a 2.5-cm tumor (closed arrow) at the foramen magnum displacing the spinal cord (open arrow) to the left. Right: Prone view showing a 2-cm tumor at the foramen magnum (arrow).

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    Left: Metrizamide-enhanced computerized tomography (CT) scan demonstrating a large, anterior, laterally placed tumor (black arrow) with compression and diplacement of the spinal cord (white arrow) to the left at the cervicomedullary junction. Right: Contrast-enhanced CT scan, low posterior fossa cut, demonstrating a large enhancing tumor at the foramen magnum (arrow).

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    Nuclear magnetic resonance scans in three patients. Left: A large clivus chordoma is demonstrated (white arrow) extending caudally toward the foramen magnum and displacing the pons posteriorly (black arrow). Center: A large syringomyelia of the cervical spinal cord can be seen (arrow) extending rostrally to the cervicomedullary junction. Right: An Arnold-Chiari malformation is revealed, with herniation of the cerebellar tonsils (black arrow) through the foramen magnum in association with a hydromyelia (white arrow).

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    Left: Nuclear magnetic resonance scan demonstrating an extradural neurofibroma (arrow) at C-3 and C-4 with displacement of the high cervical cord to the right. Right: Corresponding intraoperative photograph. The tumor (arrow) is completely extradural.

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