RETRO ODONTOID MENINGIOMA - A Rare Case report

We are presenting a rare case of retroodontoid meningioma. 46year old female presented with slowly progressive weakness of the right lower limb, followed by the right upper limb and then the left upper limb for a duration of 6 months. No other significant history. On examination, patient had quadriparesis with spasticity involving all 4 limbs and Grade 4 Power in Right lower and upper extremity , with exaggerated reflexes, more on the right. Babinskis sign was positive on both sides and the breath count was 15 breaths per minute. There was blunted proprioception on the Right toes and Rhomberg's sign was negative. Pain and temperature sensations were reduced on Right lower limbs .Lower cranial nerves and cerebellum were intact. MRI showed an extraaxial tumour extending craniocaudally from above the anterior lip of the foramen magnum to the base of the dens and transversely occupying right anterolateral position with respect to the cord, its dimensions were 4 x 3 x 2cm.A diagnosis of Spinocranial variety of Ventral foramen magnum meningioma (RetroOdontoid type) was arrived at.Treatment Through a right posterolateral approach Suboccipital craniectomy with C1, C2 and C3 laminectomy was made with the preservation of the occipital condyle , Complete microsurgical excision of the tumor was achieved . Patient was discharged on 12 th post operative day without any complication. Reference regarding similar cases in literature was made. Conclusions . Retro-odontoid meningiomas are very rare tumors, and should be included in the differential diagnosis for high cervical cord compression in foramen magnum region. The understanding of the normal and pathological anatomy is of foremost importance. The microsurgical technique is a must in dissection of these tumors.