Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 4081  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (1,135 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed1939    
    Printed58    
    Emailed1    
    PDF Downloaded35    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 5  |  Page : 539-540

Complicated lumbar ganglioneuroma


Department of Neurosurgery, West China Hospital, Sichuan University, 37 GuoXue Xiang, Wu Hou District, Chengdu, P. R. China

Date of Web Publication3-Nov-2012

Correspondence Address:
Ji L Zhang
Department of Neurosurgery, West China Hospital, Sichuan University, 37 GuoXue Xiang, Wu Hou District, Chengdu, P. R. China

Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.103216

Rights and Permissions



How to cite this article:
Chen MJ, Zhang JL, Huang SQ, You C. Complicated lumbar ganglioneuroma. Neurol India 2012;60:539-40

How to cite this URL:
Chen MJ, Zhang JL, Huang SQ, You C. Complicated lumbar ganglioneuroma. Neurol India [serial online] 2012 [cited 2020 Feb 23];60:539-40. Available from: http://www.neurologyindia.com/text.asp?2012/60/5/539/103216


Sir,

A 65-year-old woman presented with a three-month history of foot numbness associated with pain for nearly one month. Her gait and lower limb neurological examination were normal except for hypesthesia under the left knee joint. Computed tomography (CT) of the lumbar spine revealed pedicular erosion of L2-L5 vertebral bodies and enlargement of left L3-L5 intervertebral foramina [Figure 1]. Magnetic resonance imaging (MRI) of the lumbar spine revealed a large inordinate neoplasm occupying both intra-and extra-spinal spaces at L2-S1 with downward extension into the pelvic cavity. Tumor extended out through the neural foraminae at L3-L5 [Figure 2]a. There was shift of spinal cord by intraspinal tumor growth and the lesion enhanced with the contrast [Figure 2]b . An L2 to S1 hemilaminectomy was performed in a prone position through a posterior midline incision. A large extradural tumor, stuck to the dura and the left L4/5 root, was noted to extend through the L3-L5 foramen into the abdominal and pelvic cavity. The tumor was removed piecemeal after dissection of the dura and nerve roots. The patient was then turned over into a supine position. The urological surgical team accessed the residual mass through a return McIntosh point incision into the left-side retroperitoneum [Figure 3]. Her preoperative symptoms gradually relieved with no fresh neurological deficits after surgery. Histopathology of the lesion was consistent with the diagnosis of ganglioneuroma [Figure 4].
Figure 1: Preoperative CT scan revealing vertebral erosion (a, b) and enlargement of the left L2-L5 intervertebral foramina (c, d)

Click here to view
Figure 2: Sagittal (a) T1-weighted MRI showing a soft-tissue mass extending from L2 to S1. Coronal axial (b) and axial (d) MRI after intravenous contrast showing a contrast-enhancing tumor extending through the widened left intervertebral foramen (arrow). The tumor mass (c) displaces the thecal sac to the right (arrow)

Click here to view
Figure 3: Intraoperative photographs showing (a) a large-sized mass in the pelvic cavity (arrow) and (b) the excised cephalad part of the tumor

Click here to view
Figure 4: Pathologic findings of the tumor showing large ganglion cells scattered within stroma containing spindle-shaped cells (H and E, x200)

Click here to view


Ganglioneuroma is an uncommon benign tumor and originates from neural crest cells. [1] It is exceedingly rare in the lumbar region. Usually, tumors tend to acquire a large size before symptoms or clinical signs become apparent. In our patient, foot numbness with pain was the main presenting complaint. Imaging may be useful for preoperative evaluation. Regarding treatment, surgical resection is the best option to establish the diagnosis, as well as to prevent further growth and compression of adjacent structures. [2] The long-term prognosis is favorable irrespective of tumor location after total tumor excision. [3] In our patient, despite the giant and complicated tumour, complete and safe resection using microsurgical techniques was achieved with favorable results with the collaboration of multiple surgical units. Radiotherapy is not advocated in view of its benign biological course, uncertain results and malignant transformation. [4]

 
  References Top

1.Kaufman MR, Rhee JS, Fliegelman LJ, Costantino PD. Ganglioneuroma of the parapharyngeal space in a pediatric patient. Otolaryngol Head Neck Surg 2001;124:702-4.  Back to cited text no. 1
    
2.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;55:228-31.  Back to cited text no. 2
    
3.Han PP, Dickman CA. Thoracoscopic resection of thoracic neurogenic tumors. J Neurosurg 2002;96:304-8.  Back to cited text no. 3
    
4.Califano L, Zupi A, Mangone GM, Long F. Cervical ganglioneuroma: Report of a case. Otolaryngol Head Neck Surg 2001;124:115-6.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow