Meningiomas of the Foramen Magnum

M ENINGIOMAS arising at the foramen magnum produce a clinical syndrome which may be difficult to distinguish from other lesions of this region which are less amenable to therapy. The radiologic diagnosis of these tumors, by which a definitive diagnosis can be made, has received heretofore only brief attention in the literature. 15 What might be called the syndrome of compression of the cord at the foramen magnum was emphasized first by Elsberg and Strauss, 1~ Abrahamson and Grossman/and later elaborated by Symonds and Meadows/4 A clinical pattern was evident, characterized by cervico-occipital pain, weakness of the ipsilateral arm, atrophy of the small muscles of the hand, spastic paraparesis, disturbance of sense of position (especially in the upper extremities) and a paucity of cranial-nerve findings. Further general discussion on the matter of compressive spinal-cord lesions of this region was given by Cushing 6 (pp. 87-99; 171-180), Elsberg s (pp. ~97-301), Love et al. ~3 and more specifically regarding meningiomas and neurofibromas arising in this region, the works of Dodge et al. 7 and Martin and Kleyntjens 16 are pertinent. A number of authors 1,1~ have chosen to follow Cushing's 6 (p. 88) example of dividing these tumors into a variety arising above the foramen magnum--craniospinal-and those arising below the foramen magnum--spinocranial. In our opinion the former group, of which we studied a number of examples, presents as a posterior-fossa syndrome, the peculiarities of which have