Excision of dumbbell shaped ganglioneuroma of cervical spine using a facet preserving inside out approach - What we know and what we learnt

Abstract

Introduction: Cervical benign lesions present a unique opportunity to provide significant improvement in the quality of life of the patient along with the promise of a cure. Critical neurovascular structures are nearby and must be kept in mind along with the minimal bone loss to avoid postoperative instability. Ganglioneuroma of the cervical spine presents such a unique opportunity where complete excision often results in a cure. Case report: We report a case of 57 year old male with a dumbbell-shaped ganglioneuroma with an intra-dural extension which was operated via a C6–C7 hemilaminectomy and facet preserving inside-out technique under neuro-physiological monitoring and also report the all the previous such reported cases via a thorough literature search. With only 15 such cases previously reported, the traditional teaching of a rare intradural extension has now been reversed with majority of the cases having an intradural extension and dumbbell-shaped tumors. Conclusion: Although childhood in origin they present in adulthood due to their slow growth rate and multiplicity and recurrence are rare unless associated with familial syndromes. Knowledge of this rare pathology increases the index of suspicion and thus dictates the outcome of the case. Keywords: Ganglioneuroma, Dumbbell cervical tumors, Hemi-laminectomy, Primitive neuroectodermal tumors