Successful Management of a Foramen Magnum Meningioma that Presented as Recurrent Aspiration Pneumonia and was Associated with COVID-19 Pneumonia with Obstructive Sleep Apnea: A Case Report.
Keywords:
Foramen magnum, meningioma, Obstructive sleep apnea, Recurrent aspiration pneumonia, COVID-19Abstract
Foramen magnum meningiomas (FMMs) are rare and challenging tumors. We report a case of foramen magnum meningioma in a 49-year-old female who presented with obstructive sleep apnea and suffered from recurrent aspiration pneumonia. She tested positive for COVID-19. A magnetic resonance image (MRI) revealed a ventral foramen magnum mass lesion that measured 33 mm in diameter, causing a significant pressure effect on the medulla oblongata. After her pneumonia improved, a far lateral retrocondylar approach provided a safe surgical plane for the total excision of this tumor. The pathologic analysis revealed a WHO-grade-I meningioma. Rarely, FMM-compressed medulla oblongata can present with obstructive sleep apnea and recurrent aspiration pneumonia. We successfully removed the entire FMM, resolving her obstructive sleep apnea and recurrent aspiration pneumonia.
References
Paun L, Gondar R, Borrelli P, Torstein R. Meling TR. Foramen magnum meningiomas: a systematic review and meta-analysis. Neurosurg Rev. 2021; 44 (5): 2583-96.
Boulton MR, Cusimano MD. Foramen magnum meningiomas: concepts, classifications, and nuances. Neurosurg Focus. 2003; 14 (6): e10.
Talacchi A, Biroli A, Soda C, Masotto B, Bricolo A. Surgical management of ventral and ventrolateral foramen magnum meningiomas: report on a 64-case series and review ofthe literature. Neurosurg Rev. 2012; 35 (3): 359–67.
Tsao GJ, Tsang MW, Mobley BC, Cheng WW. Foramen Magnum Meningioma: Dysphagia of Atypical Etiology. J Gen Inter Med. 2007; 23 (2): 206–9.
Fatima N, Shin JH, Curry WT, Chang SD, Meola A. Microsurgical resection of foramen magnum meningioma: multi-institutional retrospective case series and proposed surgical risk scoring system. J Neurooncol. 2021, 153 (2):331–42.
Ambalavanar R, Tanaka Y, Selbie WS, Ludlow CL. Neuronal activation in the medulla Oblongata during selective elicitation of the laryngeal adductor response. J Neurophysiol. 2004, 92 (5): 2920–32.
Saito Y, Ezure K, Tanaka I. Swallowingrelated activities of respiratory and nonrespiratory neurons in the nucleus of the solitary tract in the rat. J Physiol. 2002; 540 (3): 1047–60.
Teramoto S. Swallowing, Gastroesophageal Reflux and Sleep Apnea. InTech. 2014. pp 99-111. http://dx.doi.org/ 10.5772/57577.
Liberini V, Grimaldi S, Huellner MW, Giunta F, Bachi1 C, Armellina SD, et al. COVID-19 and aspiration pneumonia: Similar pulmonary findings with different diagnoses—a pitfall in [18F] FDG PET/CT. SN Compr Clin Med. 2021; 3 (11):2322–5.
Buerki RA, Horbinski CM, Kruser T, Horowitz PM, James CD, Lukas RV. An overview of meningiomas. Future Oncol. 2018; 14 (21): 2161-77.
Wu Z, Hao S, Zhang J, Zhang L, Jia G, Tang J, et al. Foramen magnum meningiomas: experiences in 114 patients at a single institute over 15 years. Surg Neurol. 2009; 72 (4): 376–82.
Bruneau M, George B. Classification system of foramen magnum meningiomas. J Craniovertebr Junction Spine. 2010; 1 (1):10-7.
Yamahata H, Yamaguchi S, Takayasu M, Takasaki K , Osuka K, Masahiro Aoyama M, et al. Exploitation of simple classification and space created by the tumor for the treatment of foramen magnum meningiomas. World Neurosurg. 2016; 87: 1–7.
Flores BC, Boudreaux BP, Klinger DR, Mickey BE, Barnett SL. The far-lateral approach for foramen magnum meningiomas. Neurosurg Focus. 2013: 35 (6): E12.
Komotar RJ, Zacharia BE, McGovern RA, Sisti MB, Bruce JN, D’Ambrosio AL. Approaches to anterior and anterolateral foramen magnum lesions: A critical review. J Craniovertebr Junction Spine. 2010; 1 (2): 86–99.
Smith JC, Ellenberger HH, Ballanyi K, Richter DW, Feldman JL. Pre- Bötzinger complex: a brainstem region that may generate respiratory rhythm in mammals. Science. 1991; 254 (5032): 726–9.
Horner RL, Malhotra A. Control of Breathing and Upper Airways during Sleep. Murray and Nadel’s Textbook of respiratory Medicine, 7th edition. 2022. 117, pp 1618-1632.e 10.1016/B978-1- 4557-3383-5.00085-3.
Guyenet PG, Abbott SBG, Stornetta RL. The respiratory chemoreception conundrum: Light at the end of the tunnel? Brain Res. 2013; 1511: 126–37.
Schwarzacher, S.W., Rüb, U, Deller T. Neuroanatomical characteristics of the human pre-Bötzinger complex and its involvement in neurodegenerative brainstem diseases. Brain. 2011; 134 (1): 24-35.
Habek M, Brinar VV. Central sleep apnea and ataxia caused by brainstem lesion due to chronic neuroleptospirosis Neurology. 2009; 73 (22): 1923–4.
Hoffman RM, Stiller RA. Resolution of obstructive sleep apnea after microvascular brainstem decompression. Chest, 1995; 107 (2): 570–2.
Yang CF, Feldman JL. Efferent projections of excitatory and inhibitory preBötzinger Complex neurons. J Comp Neurol. 2018; 526 (8): 1389–402.
Marder E, Bucher D. Central pattern generators and the control of rhythmic movements. Curr Biol. 2001; 11 (23): R986–96.
Desai T, Khan M, Bhatt NY. Positive Airway Pressure Treatment of Adult Patients with Obstructive Sleep Apnea. Sleep Medicine Clinics. 2010; 5 (3): 347–59.
Nelson FW, Hecht JT, Horton WA, Butler IJ, Goldie WD, Minere M. Neurological basis of respiratory complications in achondroplasia. Ann Neurol. 1988; 24 (1): 89–93.
Mador MJ, Tobin MJ. Apneustic Breathing. Apneustic breathing. A characteristic feature of brainstem compression in achondroplasia? Chest. 1990; 97 (4): 877–83.
Bolser DC, Gestreau C, Morris KF, Davenport PW, Pitts TE. Central Neural Circuits for Coordination of Swallowing, Breathing, and Coughing. Otolaryngol Clin North Am. 2013; 46 (6): 957–64.
Ertekin C, Aydogdu I. Neurophysiology of swallowing. Clin Neurophysiol. 2003; 114 (12): 2226–44.
Jean A. Effet de lésions localisées du bulbe rachidien sur le stade oesophagien de la déglutition [Effect of localized lesions of the medulla oblongata on the esophageal stage of deglutition]. J. Physiol (Paris). 1972; 64 (5): 507-16.
Yoshimatsu Y, Melgaard D, Westergren A, Skrubbeltrang C, Smithard DG. The diagnosis of aspiration pneumonia in older persons: a systematic review. Eur Geriatr Med. 2022; 13 (5):1071-80.
Bolser DC, Pitts TE, Davenport PW, Morris KF. Role of the dorsal medulla in the neurogenesis of airway protection. Pulm Pharmacol Ther. 2015; 35: 105–10.
Carretero RG, Brugera MR, Rebollo- Aparicio N, Rodeles-Melero J. Dysphagia and aspiration as the only manifestations of a stroke. BMJ Case Reports. 2016; 112016:bcr2015213817.
Kim H, Chung CS, Lee KH, Robbins J. Aspiration subsequent to a pure medullary infarction: Lesion Sites, Clinical Variables, and Outcome. Arch Neurol. 2000; 57 (4): 478–83.
Aydogdu I, Ertekin C, Tarlaci S, Turman B, Kiylioglu N, Secilet Y. Dysphagia in Lateral Medullary Infarction (Wallenberg’s Syndrome) : An acute disconnection syndrome in premotor neurons related to swallowing activity? Stroke. 2001; 32 (9): 2081-7.
Pavšič K, Fabjan A, Zgonc V, Popović KŠ, Oblak JP, Bajrović FF. Clinical and radiological characteristics associated with respiratory failure in unilateral lateral medullary infarction. J Stroke Cerebrovas Dis. 2021; 30 (9): 105947.
Zarei F, Reza J, Sefidbakht S, Iranpour P, Haghighi RR. Aspiration pneumonia or COVID-19 Infection: A Diagnostic Challenge. Acad Radiol. 2020; 27 (7): 1046.
Touihmi S, Hassouni AE, Rkain I. Sars- Cov-19 associated with aspiration pneumonia in a patient with Parkinson disease: A case report. Eur J Radiol Open. 2021; 8: 100379.
Mandell LA, Niederman MS. Aspiration Pneumonia. N Engl J Med. 2019; 380 (7): 651-63.
Chaimayo C, Kaewnaphan B, Tanlieng N, Athipanyasilp N, Sirijatuphat R, Chayakulkeeree M, et al. Rapid SARS-CoV-2 antigen detection assay in comparison with real-time RT-PCR assay for laboratory diagnosis of COVID-19 in Thailand. Virol J. 2020; 17 (1): 177.
Matsushita Y, Kurihara S, Omura K, Kojima H. Delay of COVID-19 diagnosis due to aspiration pneumonia. Auris Nasus Larynx. 2022; 49 (5): 885-8.
Wijaya OJ, Ardiansyah D. Foramen magnum meningioma presented as cervical myelopathy in a pregnant COVID-19 patient: A case report. Ann Med Surg (Lond). 2022; 77: 103647.
Fiolet T, Kherabi Y, MacDonald CJ, Ghosn J, Peiffer-Smadja N. Comparing COVID-19 vaccines for their characteristics, efficacy and effectiveness against SARS-CoV-2 and variants of concern: A narrative review. Clin Microbiol Infect. 2022; 28 (2): 202-21.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Greater Mekong Subregion Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
