• Subhas Konar, Shyamal C Bir, Tanmoy Kumar Maiti, Piyush Kalakoti, and Anil Nanda.
• Department of Neurosurgery, Louisiana State University Health-Shreveport, Shreveport, Louisiana, USA.
• World Neurosurg. 2016 Jan 1; 85: 364.e1-4.

BackgroundMeningiomas of the foramen magnum are among the most challenging of all skull base lesions. Controversies continue regarding the most appropriate approach to this critical anatomic region. The authors report a first case in English literature about twin meningiomas arising from both sides of the ventrolateral dura at the foramen magnum.Case DescriptionPreoperative imaging showed a solitary mass engulfing the lower medulla. However, intraoperatively a twin mass was discovered. It encased the right side vertebral artery (VA) and abutted the left side. The unilateral far lateral transcondylar approach is not enough to resect both tumors at the same time. However, the far lateral transcondylar approach in both sides may compromise the stability and increase the risk of injury to either side of the neurovascular structures.ConclusionsWe suggest that resection can be safely achieved via the unilateral far lateral transcondylar approach followed by Gamma Knife radiosurgery (GKRS) or a staged bilateral approach.Published by Elsevier Inc.

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