Foramen Magnum Meningioma with Brainstem Compression During Pregnancy

BACKGROUND: Meningiomas can present during pregnancy as the result of hormonal as well as fluid changes. Foramen magnum meningiomas are particularly rare. We present the first reported case successfully treated during pregnancy. CASE DESCRIPTION: A 34-year-old female patient in her second trimester of pregnancy presented with a several-week history of neck pain, clonus, and right-sided upper extremity weakness. Magnetic resonance imaging of the brain demonstrated a 3.5-cm foramen magnum meningioma causing severe compression of the cervicomedullary junction. The patient underwent a far lateral craniotomy with successful decompression of the brainstem, resection of the tumor, and no permanent postoperative neurologic deficits. She made an excellent recovery and delivered a normal baby at 38 weeks with no complications. A small residual tumor engulfing the vertebral artery was treated with stereotactic radiosurgery 3 months postpartum. Diagnostic and treatment challenges unique to this case are discussed. CONCLUSIONS: Large skull base tumors symptomatic in pregnancy can be safely treated with careful planning and close monitoring.