Microsurgical Excision of Ganglioneuroma Arising from the C8 Nerve Root within the Neuroforamen

Abstract

Ganglioneuromas are benign, slow-growing tumors originating from sympathetic nerves or peripheral nerves, often associated with multiple tumor syndromes. They occasionally occur as spinal lesions and grow within the spinal canal or as paraspinal lesions. In this report, we describe a rare solitary ganglioneuroma arising from the cervical nerve root (C8) within the intervertebral foramen in adults. The tumor could be detected as a mass limited to the neuroforamen at an early stage by MR images. Unilateral microsurgical foraminotomy and en bloc resection of the tumor resulted in disappearance of the symptoms. Microsurgical resection of the relevant nerve root through limited medial foraminotomy at an intricate anatomical region of the cervico-thoracic junction was appropriate in the current case for complete resection of the tumor as well as to prevent postoperative structural weakness that could result in late segmental instability.

Key words

ganglioneuroma - cervical nerve root - neuroforamen - microsurgery

References

• 1 Enzinger FM, Weiss SW. Ganglioneuroma. In: Soft tissue tumor. St. Louis, Mosby 1995: 942-944
• 2 Shimada H, Brodeur GM. Tumors of peripheral neuroblasts and ganglion cells. In: Bigner D, McLendon R, Bruner J (eds). Russell and Rubinstein's Pathology of Tumors of the Nervous System. New York, Oxford University Press 1998: 493-533
• 3 Kyoshima K, Sakai K, Kanaji M, Oikawa S, Kobayashi S, Sato A, Nakayama J. Symmetric dumbbell ganglioneuromas of bilateral C2 and C3 roots with intradural extension associated with von Recklinghausen's disease: case report.  Surg Neurol. 2004;  61 468-473
• 4 Shekitka KM, Sobin LH. Ganglioneuromas of the gastrointestinal tract. Relation to von Recklinghausen disease and other multiple tumor syndromes.  Am J Surg Pathol. 1994;  18 250-257
• 5 Kimura S, Kawaguchi S, Wada T, Nagoya S, Yamashita T, Kikuchi K. Rhabdomyosarcoma arising from a dormant dumbbell ganglioneuroma of the lumbar spine: a case report.  Spine. 2002;  27 E513-E517
• 6 Modha A, Paty P, Bilsky MH. Presacral ganglioneuromas. Report of five cases and review of the literature.  J Neurosurg Spine. 2005;  2 366-371
• 7 Ng TH, Fung CF, Goh W, Wong VC. Ganglioneuroma of the spinal cord.  Surg Neurol. 1991;  35 147-151
• 8 Radin R, David CL, Goldfarb H, Francis IR. Adrenal and extra-adrenal retroperitoneal ganglioneuroma: imaging findings in 13 adults.  Radiology. 1997;  202 703-707
• 9 Radulovi DV, Branislav D, Skender-Gazibara MK, Igor NM. Cervical dumbbell ganglioneuroma producing spinal cord compression.  Neurol India. 2005;  53 370-371
• 10 Strang RR, Nordenstam H. Dumb-bell ganglioneuroma of the cervical spine.  Acta Neurol Scand. 1962;  38 60-66
• 11 Ugarriza LF, Cabezudo JM, Ramirez JM, Lorenzana LM, Porras LF. Bilateral and symmetric C1-C2 dumbbell ganglioneuromas producing severe spinal cord compression.  Surg Neurol. 2001;  55 228-231
• 12 Pang BC, Tchoyoson Lim CC, Tan KK. Giant spinal ganglioneuroma.  J Clin Neurosci. 2005;  12 967-972
• 13 Baba H, Chen Q, Uchida K, Imura S, Morikawa S, Tomita K. Laminoplasty with foraminotomy for coexisting cervical myelopathy and unilateral radiculopathy: a preliminary report.  Spine. 1996;  21 196-202
• 14 Kleihues P, Burger PC, Scheithauer BW. Illustrations. In: Histological typing of tumours of the central nervous system, WHO international histological classification of tumours. 2nd Edn., New York, Springer Verlag 1993: 105
• 15 Chen GH, He JN. Malignant ganglioneuroma of adrenals with metastasis to liver and spleen.  Chin Med J (Engl). 1986;  99 261-263
• 16 Cannady SB, Chung BJ, Hirose K, Garabedian N, Van Den Abbeele T, Koltai PJ. Surgical management of cervical ganglioneuromas in children.  Int J Pediatr Otorhinolaryngology. 2006;  70 287-294
• 17 Miura Y, Okumichi T, Yoshioka K, Okumichi K, Kajihara H. Successful excision of a “dumb-bell” shaped ganglioneuroma of the posterior mediastinum with a large intraspinal component.  Eur J Surg. 1993;  159 635-638
• 18 Oro JJ, Geise AW. Dumbbell ganglioneuroma of the lumbar spine associated with a herniated intervertebral disc: case report.  Neurosurgery. 1983;  13 711-714
• 19 Marmor E, Fourney DR, Rhines LD, Skibber JM, Fuller GN, Gokaslan ZL. Sacrococcygeal ganglioneuroma.  J Spinal Disord Tech. 2002;  15 265-268
• 20 Russo CP, Katz DS, Corona Jr RJ, Winfield JA. Gangliocytoma of the cervicothoracic spinal cord.  AJNR Am J Neuroradiol. 1995;  16 889-891
• 21 Levy DI, Bucci MN, Weatherbee L, Chandler WF. Intradural extramedullary ganglioneuroma: case report and review of the literature.  Surg Neurol. 1992;  37 216-218
• 22 Kobayashi S, Uchida K, Kukubo Y, Yayama T, Nakajima H, Inukai T, Nomura E, Baba H. A schwannoma of the S1 dural sleeve was resected while the intact nerve fibers were presented using a microscope. Report of a case with early MRI findings.  Minim Invas Neurosurg. 2007;  50 1-4
• 23 Nowinski GP, Visarius H, Nolte LP, Herkowitz HN. A biomechanical comparison of cervical laminaplasty and cervical laminectomy with progressive facetectomy.  Spine. 1993;  18 1995-2004
• 24 Uchida K, Baba H, Maezawa Y, Chen Q, Imura S. Lumbosacral dumb-bell neurilemmoma approached by microsurgical interlaminar foraminotomy.  Int Orthop. 1996;  20 119-122

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