Far Lateral Craniotomy for Resection of Foramen Magnum Meningioma.

 Foramen magnum meningiomas present a formidable challenge to resection due to frequent involvement of the lower cranial nerves and vertebrobasilar circulation. The video shows the use of a far lateral craniotomy to resect a foramen magnum meningioma.  A 49-year-old woman presented with neck pain and was found to have a large foramen magnum meningioma ( Fig. 1A, B ). Drilling of the posterior occipital condyle was required to gain access to the lateral aspect of the brain stem. The amount of occipital condyle resection varies by patient and pathology.  Maximal total resection of the tumor was achieved ( Fig. 1B, C ), and the patient was discharged on postoperative day 4 with no neurologic deficits. The technique for tumor microdissection ( Fig. 2 ) is shown in the video.  Given the close proximity of foramen magnum meningiomas to vital structures at the craniocervical junction, surgical resection with careful microdissection and preservation of the overlying dura to prevent postoperative pseudomeningocele is necessary to successfully manage this pathology in those patients who are surgical candidates. The link to the video can be found at: https://youtu.be/Mds9N1x2zE0 .