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Meningiomas are benign tumors dependent on arachnoid cells. Localization to the foramen magnum is rare and represents a surgical challenge. Surgical planning is crucial to choose an optimal approach and to avoid morbidity. We report a case of anterolateral meningioma of the craniocervical junction in a 49-year-old female patient with complaints of progressive weakness of the right arm for the past 6 months. Magnetic resonance imaging showed an extramedullary intradural tumor with dural insertion regarding the body of C1 vertebrae. The patient underwent surgery via suboccipital approach with a C1 laminectomy and a Simpson grade 2 resection was performed. The patient improved postoperatively and returned to her daily activities. We perform a literature review to discuss the considerations for the optimal surgical strategy for the approach of foramen magnum meningiomas.

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