Objective To evaluate the changes in surgical approaches and treatment strategies for foramen magnum(FM)meningiomas located in the anterior or anterolateral aspect of the medulla oblongata.Methods The clinical data of 72 patients suffering a meningioma attached to dura of the anterior or anterolateral FM rim admitted to General Hospital of the People's Liberation Army from January 2007 to January 2022 were analyzed retrospectively.The relevant literature were reviewed.Results Tumor removal was accomplished via a posterolateral suboccipital retrocondylar approach in all patients.Total resection was achieved in 65 patients(90％).7 patients(10％)of subtotal resection underwent cyberknife radiosurgery.12 cases(17％)had hypoglossal nerve dysfunction,and 8 improved within 3 months after surgery.18 cases(25％)experienced hoarseness and/or difficulty swallowing,15 improved within 3 months after surgery,and 1 underwent tracheotomy due to posterior cranial nerve paralysis.1 suffered from hemiplegia due to anterior spinal artery injury.There were no surgical deaths.No tumor recurrence was observed after a mean follow-up period of 3 years(range,12-60 months)with clinical and MRI examination.Conclusions Microsurgery via retrocondylar approach to remove anterior and anterolateral FM meningiomas can not only meet the needs of surgical exposure,but also avoid excessive bone grinding,achieving good total resection rate,low complications,and long-term satisfactory therapeutic effect.The occurrence of serious complications such as postoperative hemiplegia is mainly due to intraoperative vascular damage.
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