← Back to Previous Page

 

S244: SURGICAL OUTCOMES AND FUNCTIONAL MORBIDITY FOLLOWING RETROSIGMOID AND MIDLINE-SUBOCCIPITAL APPROACHES FOR FORAMEN MAGNUM MENINGIOMAS: A SINGLE-ARM META-ANALYSIS
Khushal Gupta, MBBS¹; Michael Karsy, MD, PhD, MSc, FAANS, FCNS²; ¹Bharat Ratna Late Shri Atal Bihari Vajpayee Memorial Medical College; ²University of Michigan Health

Background: Foramen magnum meningiomas (FMMs) are rare but formidable tumors at the craniocervical junction, where even small surgical maneuvers can result in major neurological consequences. The retrosigmoid and midline-suboccipital approaches remain widely used because they provide exposure with limited condylar drilling, yet their balance of safety and long-term functional outcomes is not well defined. To address this, we conducted a systematic review and single-arm meta-analysis of reported surgical outcomes, functional recovery, and complications.

Methods: We systematically searched PubMed, Embase, Scopus, and Web of Science through July 2025, following PRISMA guidelines. Studies were eligible if they included ≥5 patients with FMMs treated via retrosigmoid or midline-suboccipital approaches. Two independent reviewers extracted data on tumor characteristics, extent of resection, complications, and long-term neurological outcomes. Pooled proportions were calculated with a random-effects model using Freeman–Tukey transformation. Heterogeneity was assessed with I² statistics. Primary outcomes were gross total resection (GTR) and long-term functional independence; secondary outcomes included neurological improvement, cranial nerve (CN) morbidity, cerebrospinal fluid (CSF) leak, recurrence, and mortality. The average follow-up across included studies was 52 months (≈4.3 years).

Results: A total of 102 patients from six studies were included. The pooled GTR rate was 85% (95% CI: 77–92). Long-term tumor control showed a recurrence rate of 3% (95% CI: 0–9). At long-term follow-up, 83% of patients (95% CI: 74–91) remained functionally independent, and 76% (95% CI: 59–90) experienced improvement in preoperative neurological function. New or persistent CN deficits occurred in 23% of patients (95% CI: 9–39), while CSF leak was reported in 16% (95% CI: 7–27). Perioperative mortality was 8% (95% CI: 3–15). This figure may be influenced by older series and should be interpreted cautiously in the context of modern perioperative care.

Conclusions: Our pooled analysis suggests that retrosigmoid and midline-suboccipital approaches for FMMs achieve favorable rates of tumor control and long-term functional independence, with recurrence remaining low over a mean follow-up of more than four years. However, cranial nerve morbidity (23%) and perioperative mortality (8%) highlight the delicate trade-offs involved in operating within this anatomically compact and functionally critical region. These findings reinforce the importance of meticulous microsurgical technique, careful patient selection, and long-term follow-up in this challenging patient population.

 

← Back to Previous Page