Foramen magnum meningioma with atypical clinical presentation: a case report

Abstract

Meningiomas at the craniovertebral junction most commonly occur in the region of the foramen magnum, at the junction of the skull and the first cervical vertebra. This anatomical localization makes meningiomas in this region challenging for diagnosis and treatment, especially due to the proximity of vital structures such as the brainstem, spinal cord, and cranial nerves. This case report describes a middle-aged patient with a foramen magnum meningioma, initially presenting with unilateral headache and neck pain. One month before surgery, the patient experienced multiple sudden and brief falls without loss of consciousness. The clinical presentation lasted 6-7 months before the diagnosis. Neurological examination revealed subtle torticollis and symmetrical hyperreflexia in the lower extremities. Magnetic resonance imaging of the brain and cervical spine revealed the presence of a well-defined intradural mass with homogeneous contrast enhancement at the level of the craniovertebral junction. Following the Cavitron Ultrasonic Surgical Aspirator
technique, a transitional meningioma of the foramen magnum, gradus I, was pathophysiologically confirmed. Our case highlights the importance of clinical suspicion in recognizing these tumors and underscores the significance of using neuroimaging for early diagnosis and planning surgical treatment.