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LETTER TO EDITOR
Year : 2011  |  Volume : 59  |  Issue : 3  |  Page : 465--466

Giant cervicothoracic ganglioneuroma

Ji Zhang, Jin Li, Rajendra Shrestha, Shu Jiang 
 Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, China

Correspondence Address:
Ji Zhang
Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu
China




How to cite this article:
Zhang J, Li J, Shrestha R, Jiang S. Giant cervicothoracic ganglioneuroma.Neurol India 2011;59:465-466


How to cite this URL:
Zhang J, Li J, Shrestha R, Jiang S. Giant cervicothoracic ganglioneuroma. Neurol India [serial online] 2011 [cited 2021 Sep 27 ];59:465-466
Available from: https://www.neurologyindia.com/text.asp?2011/59/3/465/82735


Full Text

Sir,

A 24-year-old woman presented with a 15-year history of left shoulder swelling associated with left upper extremity numbness and pain for eight years. She had felt warmness around the swelling region for three years. These symptoms had gradually worsened over the past few months. Physical examination revealed a well-demarcated, soft and movable mass. Neck movement and all cervical nerves were intact. There was no family history of neurofibromatosis. Computed tomography (CT) scan disclosed pedicular erosion and enlargement of left C6-C7 intervertebral foramina [Figure 1]. Cervicothoracic magnetic resonance imaging (MRI) revealed a large extramedullary asymmetric dumbbell lesion (dimensions: 91 × 72 × 83 mm) extending outside through the neural foramen of C6-7 into the left paravertebral region of the sternocleidomastoideus, scalenus and supraclavicular fossa [Figure 2]a. The spinal cord was severely compressed by intraspinal growth of the tumor, and the enhancement was not apparent [Figure 2]b . Removal of the tumor was approached between the sternocleidomastoideus and the scalenus, combined with a posterior midline C7 hemilaminectomy. During the operation, the lesion was identified as originating from the C7 nerve root and extending to the left paravertebral region through the C6-7 intervertebral foramen. The tumor was totally resected and the C7 nerve root was preserved. Postoperative MRI confirmed complete surgical excision [Figure 3], and three-dimension CT showed a left C7 vertebral plate defect due to the operation [Figure 4]. Histopathological features [Figure 5] were consistent with the diagnosis of ganglioneuroma. The patient recovered well after surgery, and her limb numbness and pain was gradually relieved without any dysfunction of neck movement.{Figure 1}{Figure 2}{Figure 3}{Figure 4}{Figure 5}

Ganglioneuromas are rare, slow-growing, benign tumors and arise from neural crest cells or sympathetic and peripheral nerves. A solitary ganglioneuroma at the cervicothoracic region arising from the cervical nerve root within the intervertebral foramen is extremely uncommon. [1] We could review only ten published cases in the English literature [Table 1]. [2],[3],[4],[5],[6],[7],[8],[9],[10],[11] These cases were frequently dumbbell-shaped and more than half of them extended into the spinal canal through one or more intervertebral foramina. Giant ganglioneuroma as seen in our patient has not been reported in the cervical region. Regarding treatment, complete excision is the best option. [10] In our patient, despite the large tumor size, complete excision was achieved with favorable results via combined approaches. The long-term prognosis of these tumors is excellent after total tumor excision. [12] However, if total dissection of the tumor is associated with the risk of damage to neural and vascular structures, it will be appropriate to do partial decompression of the lesion and relieve the spinal cord compression. Radiotherapy was not taken, given its benign biological course and malignant transformation of the glial component. [13]{Table 1}

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