Meningiomas are common in the foramen magnum area.Due to its slow growing,the patient may be asymptomatic for a long time,and the tumor is often large in size at the time of discovery.Due to the narrow space in the foramen magnum area and the involvement of important structures such as the brain stem,the lower cranial nerves,and vertebral arteries,surgery for meningiomas in the foramen magnum area remains a technical challenge,especially the ventral foramen magnum meningiomas(vFMs).Due to the obstruction of the medulla oblongata,the cervical spinal cord,the vertebral artery and the the lower cranial nerves,exposure and removal of vFMs is extremely difficult.Sufficient revealing the base of vFMs is decisive factor of the operation,the far lateral approach is considered the first choice for removal of vFMs.However,the far lateral approach has the disadvantages of complicated craniotomy,time-consuming,severe muscle damage,and high risk of vertebral artery injury.In clinical practice,most vFMs pushed the medulla oblongata and the cervical spine to one side due to their own space-occupying effect,forming a natural tumor channel.Using this channel and posterior suboccipital approach,the author successfully removed 19 cases of ventral meningiomas in the foramen magnum area.The posterior suboccipital approach is an easy and quick approach and ideal for the majority of vFMs.
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