Classification system of foramen magnum meningiomas

BACKGROUND: Foramen magnum meningiomas (FMMs) are challenging tumors. We report a classification system based on our experience of 107 tumors. MATERIALS AND METHODS: The three main algorithm criteria included the compartment of development of the tumor, its dural insertion, and its relation to the vertebral artery. RESULTS: The compartment of development was most of the time intradural (101/107, 94.4%) and less frequently extradural (3/107, 2.8%) or both intra-extradural. (3/107, 2.8%). When developed inside the intradural compartment, FMMs were subdivided into posterior (6/104, 5.8%), lateral (57/104, 54.8%), and anterior (41/104, 39.4%), if their insertion was respectively posterior to the dentate ligament, anterior to the dentate ligament without or with extension over the midline. Anterior and lateral intradural lesions grew below (77/98, 78.6%), above (16/98, 16.3%), or on both sides (5/98, 5.1%) of the VA. Only three cases of extraduralFMMs (3/107, 2.8%) were resected by an antero-lateral approach while all the other ones (104/107, 97.2%) were removed successfully by a postero-lateral approach. Lower cranial nerves were displaced superiorly in FMM growing below the VA but their position cannot be anticipated in other situations. CONCLUSIONS: This classification system helps for defining the best surgical approach but also for anticipating the position of the lower cranial nerves and therefore for reducing the surgical morbidity.