Abstract
Morphological variations of the foramen magnum (FM) have been demonstrated to have different shapes and sizes, according to sex, age, and ethnicity. In this report, an ancient Roman skull was found to have a unique anterior notching further specified as an anterior elongation of the FM. To our knowledge, this feature has not been previously reported. The FM is one of the most challenging neurosurgical regions due to both its deep location and proximity to vital structures. Therefore, physicians and surgeons must account for FM anatomical variations in order to properly diagnose craniocervical pathology, interpret radiological images, and optimize surgical outcomes. In this case report, we describe the possible embryology and clinical importance of an apparently rare FM variant.