How I do it. Foramen magnum meningiomas. Surgical tenets for a unique pathology of a transition zone

Background Foramen magnum meningiomas (FMMs) represent significant neurosurgical challenge because of their intimate relationship with highly functional and vital neurovascular structures. Method We discuss and illustrate technical nuances to resect type 3 FMMs with anterolateral dural attachment, causing compression and displacement of the medulla oblongata, accessory nerve and upper cervical spinal cord, with encasement of vertebral artery, through far lateral approach. Conclusion Proper extradural preparation, early cerebrospinal fluid drainage, sectioning of dentate ligament, working between the nerve rootlets from caudal to rostral and from lateral to medial can enhance the safety and extent of resection.