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| LETTER TO EDITOR |
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| Year : 2005 | Volume
: 53
| Issue : 3 | Page : 370-371 |
Cervical dumbbell ganglioneuroma producing spinal cord compression
Danilo V Radulovi, D Branislav, Milica K Skender-Gazibara, Nikoli M Igor
Institute for Neurosurgery, Belgrade, Serbia and Montenegro
| Date of Acceptance | 19-Apr-2005 |
Correspondence Address:
Danilo V Radulovi
Institute for Neurosurgery, Belgrade
Serbia and Montenegro
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.16953
How to cite this article:
Radulovi DV, Branislav D, Skender-Gazibara MK, Igor NM. Cervical dumbbell ganglioneuroma producing spinal cord compression. Neurol India 2005;53:370-1 |
Sir,
A 39-year old man presented with complains of progressive weakness and numbness of all four limbs for six months. There was moderate spastic tetraparesis that was more marked on the left side, and hypoesthesia below the C5 dermatome.
Magnetic resonance imaging (MRI) showed a large extramedullary dumbbell mass at the C4-C5 level. The tumor was hypointense on the T1 and hyperintense on T2 images. The spinal cord was severely compressed [Figure - 1] A and B.
A two-staged operation was performed to resect the tumor. First, the patient was operated through a posterior cervical approach. Wide laminectomy of C4 and C5 was done. The mass was solid, well capsulated, elastic, moderately vascularised, purely extradural and ventrolaterally located to the spinal cord. The lesion originated from cervical nerve C5, which was resected with tumor [Figure - 2]A resection of intraforaminal mass was performed through the foramen which had been already enlarged by tumor growth. After four weeks the patient underwent second operation. The paraspinal extravertebral component of tumor was excised through the left lateral cervical approach [Figure - 2]B. The vertebral artery was dissected off the surface of encapsulated tumor.
At a three-year follow-up the patient had regained the motor strength in all four limbs. There was no radiographic signs of recurrence.
Histological examination of both tumor masses confirmed that the lesion was a ganglioneuroma [Figure - 3].
| » Discussion | |  |
Kyoshima et al[1] surveyed the literature on the subject and identified a total of only five pathologically confirmed cases of cervical spine ganglioneuromas. One patient was an 18-month old child and rest of the patients were young adults. Von Recklinghausen's disease was present in two patients. The symptoms spinal cord compression were present in all reported cases. Two patients had bilateral tumors. The origin of tumors was sensory root ganglion or cervical nerve. In all the reported cases, the tumor growth was in dumbbell pattern. Intraspinal extradural growth was observed in three patients, while intradural extension was seen in two patients.
On MRI about 75% of ganglioneuromas are isointense and 25% are hypointense on T1 images. Most of them are hyperintense on T2 images. The non-homogeneous appearance corresponds to areas of cystic degeneration, hemorrhage or necrotic degeneration.[4],[5]
Ganglioneuromas are well encapsulated tumors and can be completely excised. Even when they are intradural, the tumor could be removed without cord injury because they are not adherent to the spinal cord.[1] This and previously reported cases indicate that spinal ganglioneuromas could be completely removed and cured.
| » References | | |
| 1. | 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;61:468-73  |
| 2. | Maggi G, Dorato P, Trischitta V, Varone A, Civetta F. Cervical dumbbell ganglioneuroma in an eighteen month old child. A case report. J Neurosurg Sci 1995;39:257-60 |
| 3. | Ugarriza LF, Cabezudo JM, Ramirez JM, Lorenzana LM, Porras LF. Bilateral and symmetric C1-C2 dummbell ganglioneuromas producing severe spinal cord compression. Surg Neurol 2001;55:228-31 |
| 4. | Ichikawa T, Ohtomo K, Araki T, Fujimoto H, Nemoto K, Nanbu A, Onoue M, Aoki K. Ganglioneuroma: Computed tomography and magnetic resonance features. Br J Radiol 1996;69:114-21 |
| 5. | Lonergan GJ, Schwab CM, Suarez ES, Carlson CL. Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: radiologic-pathologic correlation. Radiographics 2002;22:911-34 |
Figures
[Figure - 1], [Figure - 2], [Figure - 3]
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