Surgical management of benign tumors at the foramen magnum region

Tumors in the foramen magnum region are among the most challenging neurosurgical lesions to operate. They may be divided into intradural and extradural tumors, which have differing pathologies. Meningiomas represent the most common intradural tumor in this region. Anatomical constraints caused by adjacent critical areas of the brainstem, proximity to the lower cranial nerves (CNs), and vertebral arteries add to the complexity and make total tumor resection difficult without damaging the brain stem, CNs, or the vertebral artery and branches. This review article summarizes the surgical approaches and relevant anatomical landmarks with illustrations at each step. We also illustrate with example cases, the decision-making process and highlight key strategies for the safe resection of these tumors.