Foramen magnum meningioma: long-term follow up without neurosurgery—A case report

Background Foramen magnum meningiomas can cause lower cranial nerve deficits or brain stem symptoms. When they become symptomatic or when growth is documented, surgical resection is indicated. Case presentation In a white German 79-year-old woman, a small dorsal foramen magnum meningioma was detected by cerebral magnetic resonance imaging. After 7 years, cerebral magnetic resonance imaging showed considerable tumor growth (an increase in diameters from 15 × 16 × 20 mm to 28 × 30 × 37 mm), brain stem compression, and obstructive hydrocephalus. The clinical symptoms were however mild. The patient refused surgery. After a follow-up of over 18 months, she is still able to walk and live relatively independently. Conclusions In the case of a slowly growing presumed benign intracranial tumor, deferral of surgery may be a justifiable option in old age, when symptoms are mild and social factors present an obstacle to immediate surgery. Since a spontaneous reduction in the growth rate is often observed in large intracranial meningiomas, some patients can survive with moderate deficits and a high quality of life in spite of substantial compression of the brain stem.