An Innovative Technique For Posterior Inferior Cerebellar Artery (PICA) Transposition During Foramen Magnum Meningioma Resection: A Case Report

This report outlines the successful excision of an anterolateral foramen magnum meningioma (FMM) in a 69-year-old female patient who exhibited symptoms of vertigo, numbness in the left shoulder, and a fall. Neuroimaging revealed a lesion located at the anterolateral foramen magnum. The tumor was removed using a posterior midline suboccipital approach, with meticulous dissection performed around the left posterior inferior cerebellar artery (PICA). This artery was transposed with the aid of a Yasargil 5 mm curved temporary fenestrated clip (Aesculap AG & Co., Tuttlingen, Germany) to enable a Simpson grade 2 resection. The postoperative recovery was smooth, resulting in discharge on the third day, and histopathological analysis confirmed the diagnosis of an angiomatous meningioma, classified as CNS WHO grade 1. This case highlights the practicality and efficacy of PICA transposition during the resection of anterolateral FMM, showcasing the innovative application of a temporary fenestrated clip to stabilize the vessel while maintaining vascular integrity, thus allowing for safe tumor removal. This technique presents a promising approach for the management of complex foramen magnum lesions, yielding favorable results.