Cervical symmetric dumbbell ganglioneuromas causing severe paresis

Abstract

We report an extremely rare case with bilateral and symmetric dumbbell ganglioneuromas of the cervical spine in an elderly patient. A 72-year-old man came by ambulance to our hospital due to progressive incomplete paraplegia. Magnetic resonance imaging demonstrated bilateral symmetric dumbbell tumors at the C1/2 level. We performed total resection of the intracanalar tumor, aiming at complete decompression of the spinal cord, and partial and subtotal resection of foraminal outside portions. Histopathological examination of the surgical specimen indicated the tumor cells to be spindle cells with the presence of ganglion cells and no cellular pleomorphism, suggesting a diagnosis of ganglioneuroma. Although the surgery was not curative, the postoperative course was uneventful and provided a satisfactory outcome. This is the fourth known case of cervical ganglioneuromas of the bilateral symmetric dumbbell type.

Keywords: Cervical spine; Dumbbell tumor; Ganglioneuroma; Symmetric.

Fig. 1

Preoperative magnetic resonance images. T2-weighted sagittal images. (A) Left side para-sagittal section, (B) mid-sagittal section, (C) right side para-sagittal section, revealed a heterogeneous hyperintensity (black arrow on [A] and [C]). Contrast-enhanced T1-weighted images. (D) Axial section at C1/2, (E) coronal section of spinal cord at C1/2, showed enhancement in the tumor parenchyma.

Fig. 2

Intraoperative findings. After the posterior arch at C1 and cranial portion of the C2 lamina were removed and the dura was exposed (A), extradural bilateral tumor masses at C1/2 were identifiable (extradural portions of the tumor at right side [B] and left side [C]). After durotomy, bilateral symmetric tumors originating from the bilateral C2 dorsal root were identified (intradural portions of the tumor at right side [D, black arrow] and left side [E, black arrow]).

Fig. 3

Histopathological examination. The tumor cells were found to be spindle cells with no cellular pleomorphism and presence of ganglion cells. Ganglion cells were dissipating throughout the tumor (H&E, ×100).

Fig. 4

Postoperative magnetic resonance images. Although bilateral foraminal portions were left, the intracanal tumor was resected completely and spinal cord decompression was sufficient.