枕骨大孔腹侧脑膜瘤手术入路：枕下中线or远外侧？

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脑膜瘤是枕骨大孔区的常见疾病，由于生长缓慢，患者在很长一段时间内都没有症状，所以就诊时肿瘤往往已经生长得很大，由于该处空间狭小，周围有许多重要结构，例如脑干、后组颅神经、椎动脉，所以手术非常困难，尤其是枕骨大孔腹侧脑膜瘤。由于延颈髓、椎动脉、后组颅神经的阻挡，肿瘤显露困难。充分地显露是枕骨大孔腹侧脑膜瘤手术成功的关键，因此远外侧入路理所当然成为首选入路。然而，远外侧入路也存在着开颅复杂、花费时间多、肌肉损伤严重、椎动脉损伤风险高等缺点。临床实践中，绝大多数的枕骨大孔腹侧脑膜瘤将延颈髓推向一侧，形成了自然的肿瘤通道；利用此通道，采用枕下中线入路，笔者成功切除了19例枕骨大孔区腹侧脑膜瘤。枕下中线入路是切除枕骨大孔腹侧脑膜瘤的理想入路，能简单、快捷、低风险地切除几乎所有的枕骨大孔腹侧脑膜瘤。

Meningiomas are common in the foramen magnum area. Due to its slow growing, the patient may be asymptomatic for a long time, and the tumor is often large in size at the time of discovery. Due to the narrow space in the foramen magnum area and the involvement of important structures such as the brain stem, the lower cranial nerves, and vertebral arteries, surgery for meningiomas in the foramen magnum area remains a technical challenge, especially the ventral foramen magnum meningiomas(vFMs). Due to the obstruction of the medulla oblongata, the cervical spinal cord, the vertebral artery and the the lower cranial nerves, exposure and removal of vFMs is extremely difficult. Sufficient revealing the base of vFMs is decisive factor of the operation, the far lateral approach is considered the first choice for removal of vFMs. However, the far lateral approach has the disadvantages of complicated craniotomy, time-consuming, severe muscle damage, and high risk of vertebral artery injury. In clinical practice, most vFMs pushed the medulla oblongata and the cervical spine to one side due to their own space-occupying effect, forming a natural tumor channel. Using this channel and posterior suboccipital approach, the author successfully removed 19 cases of ventral meningiomas in the foramen magnum area. The posterior suboccipital approach is an easy and quick approach and ideal for the majority of vFMs.