Abstract
Ganglioneuroma is a rare benign tumor, which is usually located in the posterior mediastinum and retroperitoneum. Occasionally, it involves the paraspinal region with intraspinal extension and becomes dumbbell shaped. Dumbbell ganglioneuromas rarely affect the lumbar spine, and only nine cases of dumbbell lumbar ganglioneuromas have been reported previously. We are reporting an extremely rare case of a giant dumbbell tumor in the lumbar spine. We performed a one stage total resection of the tumor with posterior approach and long-segment fixation and fusion. This approach is different from previous methods. Histopathological examination of the surgical specimen confirmed the diagnosis of ganglioneuroma. Thirty months follow up showed a satisfactory outcome. Single-stage posterior tumor resection with fixation and fusion is effective and an appropriate choice for the treatments of lumbar dumbbell ganglioneuromas.
Highlights
Ganglioneuroma is a rare benign tumor, which is usually located in the posterior mediastinum and retroperitoneum
Only nine cases of dumbbell lumbar ganglioneuromas have been reported [1, 8]. This is the first report regarding the complete resection of a giant dumbbell lumbar ganglioneuroma by a single posterior approach with fixation and fusion
The appearance is presumed to be caused by a combination of ganglion cells [1, 2, 14]. This patient’s interverteberal foramens between L1-2 and L2-3 were widened which was consistent with ganglioneuroma, as schwannoma and neurofibroma rarely invaded more than one foramen [8, 13]
Summary
Ganglioneuroma is a rare, slow-growing, benign tumor that arises from sympathetic ganglion along the spinal column and adrenal glands [1,2,3,4,5]. Case presentation A 29-year-old female patient was accepted in February 2013 with a 25-years history of mild weakness and numbness in both legs. Further magnetic resonance imaging (MRI) scan revealed a large intraspinal mass extending to the left paravertebral space from T11 to L3 levels. A second lumbar MRI showed a large intraspinal soft tissue mass from T11 to L3 levels. The patient had complete resolution of pain without any aggravated sensations She experienced slightly worsened weakness in left leg (from grade 4 to 4-). The immunohistochemical analysis revealed that the ganglion cells were positive for S-100 and NF, while the Schwann cells stained positive for S-100, SOX-10 These results established a histological diagnosis of ganglioneuroma (Fig. 3). There were no signs of tumor recurrence, no instrumentation-related complications, and spinal alignment was maintained
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