{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T15:22:13Z","timestamp":1790868133413,"version":"4.1.0"},"reference-count":100,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:p>Foramen magnum meningiomas (FMMs) are slow growing, most often intradural and extramedullary tumors that pose significant challenges to the skull base neurosurgeon. The indolent clinical course of FMMs and their insidious onset of symptoms are important factors that contribute to delayed diagnosis and relative large size at the time of presentation. Symptoms are often produced by compression of surrounding structures (such as the medulla oblongata, upper cervical spinal cord, lower cranial nerves, and vertebral artery) within a critically confined space. Since the initial pathological description of a FMM in 1872, various surgical approaches have been described with the aim of achieving radical tumor resection. The surgical treatment of FMMs has evolved considerably over the last 4 decades due to the progress in microsurgical techniques and development of a multitude of skull base approaches. Posterior and posterolateral FMMs can be safely resected via a standard midline suboccipital approach. However, controversy still exits regarding the optimal management of anterior or anterolateral lesions. Independently of technical variations and the degree of bone removal, all modern surgical approaches to the lower clivus and anterior foramen magnum derive from the posterolateral (or far-lateral) craniotomy originally described by Roberto Heros and Bernard George. This paper is a review of the surgical management of FMMs, with emphasis on the far-lateral approach and its variations. Clinical presentation, imaging findings, important neuroanatomical correlations, recurrence rates, and outcomes are discussed.<\/jats:p>","DOI":"10.3171\/2013.10.focus13332","type":"journal-article","created":{"date-parts":[[2013,12,1]],"date-time":"2013-12-01T03:33:23Z","timestamp":1385868803000},"page":"E12","source":"Crossref","is-referenced-by-count":57,"title":["The far-lateral approach for foramen magnum meningiomas"],"prefix":"10.3171","volume":"35","author":[{"given":"Bruno C.","family":"Flores","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin P.","family":"Boudreaux","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel R.","family":"Klinger","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce E.","family":"Mickey","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel L.","family":"Barnett","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1-0350012","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Meningiomas of the ventral foramen magnum","volume":"6","author":"Arnautovic","year":"1999"},{"issue":"1 Suppl","key":"b2-0350012","series-title":"J Neurosurg Spine","first-page":"71","article-title":"Ventral foramen magnum meningiomas","volume":"92","author":"Arnautovi\u0107","year":"2000"},{"key":"b3-0350012","series-title":"J Neurosurg","first-page":"252","article-title":"The suboccipital cavernous sinus","volume":"86","author":"Arnautovi\u0107","year":"1997"},{"key":"b4-0350012","series-title":"Neurosurgery","first-page":"1177","article-title":"Foramen magnum meningiomas: clinical outcome after microsurgical resection via a posterolateral suboccipital retrocondylar approach","volume":"59","author":"Bassiouni","year":"2006"},{"key":"b5-0350012","series-title":"Neurosurgery","first-page":"815","article-title":"The dorsolateral, suboccipital, transcondylar approach to the lower clivus and anterior portion of the craniocervical junction","volume":"29","author":"Bertalanffy","year":"1991"},{"key":"b6-0350012","series-title":"Neurosurg Rev","first-page":"49","article-title":"Surgical management of foramen magnum meningiomas","volume":"32","author":"Borba","year":"2009"},{"issue":"6","key":"b7-0350012","series-title":"Neurosurg Focus","first-page":"E10","article-title":"Foramen magnum meningiomas: concepts, classifications, and nuances","volume":"14","author":"Boulton","year":"2003"},{"key":"b8-0350012","series-title":"Neurosurg Rev","first-page":"19","article-title":"Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisi\u00e8re Hospital and review of the literature","volume":"31","author":"Bruneau","year":"2008"},{"key":"b9-0350012","series-title":"Brain","first-page":"282","article-title":"The meningiomas (dural endotheliomas): their source, and favoured seats of origin","volume":"45","author":"Cushing","year":"1922"},{"key":"b10-0350012","series-title":"Meningiomas: Their Classification, Regional Behavior, Life History and Surgical End Results","first-page":"785","author":"Cushing","year":"1938"},{"key":"b11-0350012","series-title":"Surg Neurol","first-page":"293","article-title":"Microsurgical anatomy of the region of the foramen magnum","volume":"24","author":"de Oliveira","year":"1985"},{"key":"b12-0350012","series-title":"Arch Neurol Psychiatry","first-page":"261","article-title":"Tumors of the spinal cord which project into the posterior cranial fossa. 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Clinical article","volume":"112","author":"Sanai","year":"2010"},{"key":"b41-0350012","series-title":"J Neurooncol","first-page":"249","article-title":"Petroclival and foramen magnum meningiomas: surgical approaches and pitfalls","volume":"29","author":"Sekhar","year":"1996"},{"key":"b42-0350012","series-title":"Acta Neurochir (Wien)","first-page":"70","article-title":"Surgical management of anteriorly placed lesions at the craniocervical junction\u2014an alternative approach","volume":"108","author":"Sen","year":"1991"},{"issue":"6","key":"b43-0350012","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Anatomical basis of approaches to foramen magnum and lower clival meningiomas: comparison of retrosigmoid and transcondylar approaches","volume":"14","author":"Suhardja","year":"2003"},{"key":"b44-0350012","series-title":"Neurosurg Rev","first-page":"359","article-title":"Surgical management of ventral and ventrolateral foramen magnum meningiomas: report on a 64-case series and review of the literature","volume":"35","author":"Talacchi","year":"2012"},{"issue":"1 Suppl","key":"b45-0350012","series-title":"J Neurosurg","first-page":"91","article-title":"Stability of the craniovertebral junction after unilateral occipital condyle resection: a biomechanical study","volume":"90","author":"Vishteh","year":"1999"},{"key":"b46-0350012","series-title":"J Neurosurg","first-page":"555","article-title":"Microsurgical anatomy of the transcondylar, supracondylar, and paracondylar extensions of the far-lateral approach","volume":"87","author":"Wen","year":"1997"},{"key":"b47-0350012","series-title":"Surg Neurol","first-page":"376","article-title":"Foramen magnum meningiomas: experiences in 114 patients at a single institute over 15 years","volume":"72","author":"Wu","year":"2009"},{"key":"b48-0350012","series-title":"Adv Tech Stand Neurosurg","first-page":"3","article-title":"Meningiomas of basal posterior cranial fossa","volume":"7","author":"Ya\u015fargil","year":"1980"},{"key":"b49-0350012","series-title":"J Neurosurg","first-page":"828","article-title":"Foramen magnum tumors. Analysis of 57 cases of benign extramedullary tumors","volume":"49","author":"Yasuoka","year":"1978"},{"key":"b50-0350012","series-title":"J Neurosurg","first-page":"864","article-title":"Gamma Knife surgery in the treatment paradigm for foramen magnum meningiomas. 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Report of a case in which a growth was removed from the ventral and lateral aspects of the medulla oblongata and upper cervical cord","volume":"21","author":"Elsberg","year":"1929"},{"key":"b13-0350012","series-title":"Arch Neurol Psychiatr (Chicago)","first-page":"455","article-title":"An analysis of fourteen consecutive cases of spinal cord tumor","volume":"8","author":"Frazier","year":"1922"},{"key":"b14-0350012","series-title":"Surg Neurol","first-page":"484","article-title":"Lateral approach to the anterior portion of the foramen magnum. Application to surgical removal of 14 benign tumors: technical note","volume":"29","author":"George","year":"1988"},{"key":"b15-0350012","series-title":"Surg Neurol","first-page":"371","article-title":"Meningioma of the foramen magnum: a series of 40 cases","volume":"47","author":"George","year":"1997"},{"key":"b16-0350012","series-title":"Neurosurgery","first-page":"779","article-title":"Extreme lateral approach to intradural lesions of the cervical spine and foramen magnum","volume":"28","author":"Gilsbach","year":"1991"},{"key":"b17-0350012","series-title":"Neurosurgery","first-page":"102","article-title":"Surgery on anterior foramen magnum meningiomas using a conventional posterior suboccipital approach: a report on an experience with 17 cases","volume":"49","author":"Goel","year":"2001"},{"key":"b18-0350012","series-title":"Journal of Neurosurgical Review","article-title":"Microsurgical anatomy of the far-lateral ap-proach and its transcondylar and supracondylar extensions","author":"Graziano"},{"key":"b19-0350012","series-title":"Br J Neurosurg","first-page":"164","article-title":"Posterior midline approach for large anterior\/anterolateral foramen magnum tumours","volume":"18","author":"Gupta","year":"2004"},{"key":"b20-0350012","series-title":"Gaz Med (Paris)","first-page":"2","article-title":"Note sur deux faits de tumeur de mesocephale","volume":"3","author":"Hallopeau","year":"1874"},{"key":"b21-0350012","series-title":"J Neurosurg","first-page":"559","article-title":"Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions","volume":"64","author":"Heros","year":"1986"},{"key":"b22-0350012","series-title":"Br J Neurosurg","first-page":"33","article-title":"Foramen magnum meningiomas\u2014experience with the posterior suboccipital approach","volume":"23","author":"Kandenwein","year":"2009"},{"key":"b23-0350012","series-title":"Acta Neurochir (Wien)","first-page":"79","article-title":"Meningiomas of the ventral foramen magnum and lower clivus: factors influencing surgical morbidity, the extent of tumour resection, and tumour recurrence","volume":"152","author":"Kano","year":"2010"},{"issue":"1","key":"b24-0350012","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Expanded endonasal approach: the rostrocaudal axis. 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Clinical article","volume":"112","author":"Sanai","year":"2010"},{"key":"b41-0350012","series-title":"J Neurooncol","first-page":"249","article-title":"Petroclival and foramen magnum meningiomas: surgical approaches and pitfalls","volume":"29","author":"Sekhar","year":"1996"},{"key":"b42-0350012","series-title":"Acta Neurochir (Wien)","first-page":"70","article-title":"Surgical management of anteriorly placed lesions at the craniocervical junction\u2014an alternative approach","volume":"108","author":"Sen","year":"1991"},{"issue":"6","key":"b43-0350012","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Anatomical basis of approaches to foramen magnum and lower clival meningiomas: comparison of retrosigmoid and transcondylar approaches","volume":"14","author":"Suhardja","year":"2003"},{"key":"b44-0350012","series-title":"Neurosurg Rev","first-page":"359","article-title":"Surgical management of ventral and ventrolateral foramen magnum meningiomas: report on a 64-case series and review of the literature","volume":"35","author":"Talacchi","year":"2012"},{"issue":"1 Suppl","key":"b45-0350012","series-title":"J Neurosurg","first-page":"91","article-title":"Stability of the craniovertebral junction after unilateral occipital condyle resection: a biomechanical study","volume":"90","author":"Vishteh","year":"1999"},{"key":"b46-0350012","series-title":"J Neurosurg","first-page":"555","article-title":"Microsurgical anatomy of the transcondylar, supracondylar, and paracondylar extensions of the far-lateral approach","volume":"87","author":"Wen","year":"1997"},{"key":"b47-0350012","series-title":"Surg Neurol","first-page":"376","article-title":"Foramen magnum meningiomas: experiences in 114 patients at a single institute over 15 years","volume":"72","author":"Wu","year":"2009"},{"key":"b48-0350012","series-title":"Adv Tech Stand Neurosurg","first-page":"3","article-title":"Meningiomas of basal posterior cranial fossa","volume":"7","author":"Ya\u015fargil","year":"1980"},{"key":"b49-0350012","series-title":"J Neurosurg","first-page":"828","article-title":"Foramen magnum tumors. 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