How I do it: endoscopic endonasal transclival resection of ventral foramen magnum meningioma.

Lin, Yen-Yu; Yeh, Chien-Fu; Lan, Ming-Ying; Wang, Wei-Hsin · Acta Neurochir (Wien) · 2026

other · Level V

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Abstract

Surgical management of ventral foramen magnum meningiomas (FMMs) is challenging due to intervening neurovascular structures. The endoscopic endonasal transclival approach provides a direct access, offering a potential route to achieve Simpson Grade 1 resection while minimizing brainstem retraction. We detail the technical nuances of a binostril, four-handed EEA for a ventral FMM. We explain the key anatomical landmarks required for safe decompression, including clival drilling limits, the identification of pre-medullary neurovascular structures, and the execution of a multilayered reconstruction. The EEA is a safe alternative for ventral FMMs in cases without significant lateral or caudal extension.