Sympathetic Ganglion Cells Research Articles

Combined unilateral biportal endoscopy and video-assisted thoracoscopic surgery for complete excision of a T3-T4 right ganglioneuroma.

Ganglioneuroma (GN) is a rare solid neoplasm developing from neural crest cells of sympathetic ganglia or adrenal medulla. It usually presents as an asymptomatic mass in the retroperitoneal space and mediastinum. Resection through open surgery or minimal access is recommended. The video illustrates the case of a 23-year-old female with an incidental finding of thoracic GN. The authors performed a combined, staged approach to ensure complete resection, which involved unilateral T3-4 biportal endoscopy (UBE) for rhizotomy and nerve root decompression, followed by video-assisted thoracoscopic surgery (VATS) for complete excision. The procedure was uneventful, with full recovery and no postoperative complications. The video can be found here: https://stream.cadmore.media/r10.3171/2024.2.FOCVID23210.

The causal relationship between gut microbiota and neuroblastoma: a bidirectional Mendelian randomization analysis and meta-analysis.

Bidirectional Mendelian randomization was used to explore the causality between gut microbiota and neuroblastoma (NB). The results showed that there is a causal relationship between the six gut microbiota and NB, of which two gut microbiota were further confirmed in the meta-analysis. This may provide a new perspective on the prevention and treatment of NB.

Store-operated calcium entry in the satellite glial cells of rat sympathetic ganglia.

Satellite glial cells (SGCs), a major type of glial cell in the autonomic ganglia, closely envelop the cell body and even the synaptic regions of a single neuron with a very narrow gap. This structurally unique organization suggests that autonomic neurons and SGCs may communicate reciprocally. Glial Ca2+ signaling is critical for controlling neural activity. Here, for the first time we identified the machinery of store-operated Ca2+ entry (SOCE) which is critical for cellular Ca2+ homeostasis in rat sympathetic ganglia under normal and pathological states. Quantitative realtime PCR and immunostaining analyses showed that Orai1 and stromal interaction molecules 1 (STIM1) proteins are the primary components of SOCE machinery in the sympathetic ganglia. When the internal Ca2+ stores were depleted in the absence of extracellular Ca2+, the number of plasmalemmal Orai1 puncta was increased in neurons and SGCs, suggesting activation of the Ca2+ entry channels. Intracellular Ca2+ imaging revealed that SOCE was present in SGCs and neurons; however, the magnitude of SOCE was much larger in the SGCs than in the neurons. The SOCE was significantly suppressed by GSK7975A, a selective Orai1 blocker, and Pyr6, a SOCE blocker. Lipopolysaccharide (LPS) upregulated the glial fibrillary acidic protein and Toll-like receptor 4 in the sympathetic ganglia. Importantly, LPS attenuated SOCE via downregulating Orai1 and STIM1 expression. In conclusion, sympathetic SGCs functionally express the SOCE machinery, which is indispensable for intracellular Ca2+ signaling. The SOCE is highly susceptible to inflammation, which may affect sympathetic neuronal activity and thereby autonomic output.

Mesane Paragangliomu: Olgu sunumu

The majority of bladder lesions are papillary and/or flat-appearing urothelial neoplasms. Neoplasms besides urothelial tumors are very rare. Paragangliomas are rare catecholamine-releasing tumors of sympathetic ganglion or chromaffin cell origin. Approximately 10% of paragangliomas occur in the non-adrenal region, of which 10% are seen in the bladder and constitute 0.05% of all bladder tumors. In a 42-year-old female patient, a 50x43 mm solid mass protruding into the lumen on the left anterolateral aspect of the bladder was observed with necrotic center and increased vascularity on the periphery. The specimens of the TUR material obtained from an external center and our hospital were examined by pathology and diagnosed as paraganglioma. Because of its rarity and confusion with urothelial carcinoma, paraganglioma should always be kept in mind when dealing with bladder tumors.

Muscarinic Receptor Stimulation Does Not Inhibit Voltage-dependent Ca2+ Channels in Rat Adrenal Medullary Chromaffin Cells.

Adrenal medullary chromaffin (AMC) and sympathetic ganglion cells are derived from the neural crest and show a similar developmental path. Thus, these two cell types have many common properties in membrane excitability and signaling. However, AMC cells function as endocrine cells while sympathetic ganglion cells are neurons. In rat sympathetic ganglion cells, muscarinic M1 and M4 receptors mediate excitation and inhibition via suppression of M-type K+ channels and suppression of voltage-dependent Ca2+ channels, respectively. On the other hand, M1 receptor stimulation in rat AMC cells also produces excitation by suppressing TWIK-related acid sensitive K+ (TASK) channels. However, whether M4 receptors are coupled with voltage-dependent Ca2+ channel suppression is unclear. We explore this issue electrophysiologically and biochemically. Electrical stimulation of nerve fibers in rat adrenal glands trans-synaptically increased the Ca2+ signal in AMC cells. This electrically evoked increased Ca2+ signal was not altered during muscarine-induced increase in Ca2+ signal, whereas it decreased significantly during a GABA-induced increase, due to a shunt effect of increased Cl- conductance. The whole-cell current recordings revealed that voltage-dependent Ca2+ currents in AMC cells were suppressed by adenosine triphosphate, but not by muscarinic agonists. The fractionation analysis and immunocytochemistry indicated that CaV1.2 Ca2+ channels and M4 receptors are located in the raft and non-raft membrane domains, respectively. We concluded that muscarinic stimulation in rat AMC cells does not produce voltage-dependent Ca2+ channel inhibition. This lack of muscarinic inhibition is at least partly due to physical separation of voltage-dependent Ca2+ channels and M4 receptors in the plasma membrane.

Chlorogenic Acid Induced Neuroblastoma Cells Differentiation via the ACAT1-TPK1-PDH Pathway.

Chlorogenic acid (CHA) has been shown to have substantial biological activities, including anti-inflammatory, antioxidant, and antitumor effects. However, the pharmacological role of CHA in neuroblastoma has not yet been assessed. Neuroblastoma is a type of cancer that develops in undifferentiated sympathetic ganglion cells. This study aims to assess the antitumor activity of CHA against neuroblastoma and reveal its mechanism of action in cell differentiation. Be(2)-M17 and SH-SY5Y neuroblastoma cells were used to confirm the differentiation phenotype. Subcutaneous and orthotopic xenograft mouse models were also used to evaluate the antitumor activity of CHA. Seahorse assays and metabolomic analyses were further performed to investigate the roles of CHA and its target ACAT1 in mitochondrial metabolism. CHA induced the differentiation of Be(2)-M17 and SH-SY5Y neuroblastoma cells in vivo and in vitro. The knockdown of mitochondrial ACAT1, which was inhibited by CHA, also resulted in differentiation characteristics in vivo and in vitro. A metabolomic analysis revealed that thiamine metabolism was involved in the differentiation of neuroblastoma cells. These results provide evidence that CHA shows good antitumor activity against neuroblastoma via the induction of differentiation, by which the ACAT1-TPK1-PDH pathway is involved. CHA is a potential drug candidate for neuroblastoma therapy.

1041 Recurrent Retropharyngeal Ganglioneuroma in a Pediatric Patient

Abstract Introduction Ganglioneuroma is a rare benign subtype of peripheral neuroblastic tumor that arises from sympathetic ganglion cells. Fewer than 10% of these cases occur in the head and neck and are rarely seen in pediatric patients. Clinical symptoms and treatment are dependent on mass location and extension. The authors present a case of recurrent retropharyngeal ganglioneuroma in a pediatric patient. Report of case(s) Patient is a 2-year-old previously healthy female who presented with progressive snoring and found to have retropharyngeal lymphadenopathy during tonsillectomy. Differential diagnosis included retropharyngeal abscess; however, after no improvement with antibiotics, malignancy was suspected. Pathology results from a needle biopsy confirmed the diagnosis of ganglioneuroma. CT imaging showed extension of mass to bilateral retropharyngeal, posterior mediastinal and paraspinal, and retroperitoneal spaces. Given concerns for significant morbidity with complete resection, patient underwent partial resection of mass, followed by chemotherapy to decrease tumor burden. Patient initially did well, then developed nine-month progressive snoring, positional apnea, persistent stertor, and dysphagia. Sleep study showed severe obstructive sleep apnea (OSA) with apnea hypopnea index (AHI) 74, oxygen nadir 66%, and maximum transcutaneous carbon dioxide (CO2) level of 58 mmHg. Repeat CT imaging showed regrowth of the tumor with large right-sided retropharyngeal mass, mass effect on right oropharynx and associated vasculature, and moderate narrowing of airway. Supplemental oxygen via nasal cannula was initiated as inpatient, due to concerns that noninvasive positive pressure support would further compromise the critical airway. Urgent repeat debulking of the tumor with partial pharyngectomy was completed. Post-operatively, patient's oxygen dependence, stertor, and positional apnea resolved within 24 hours. Repeat sleep study showed considerable improvement with mild OSA, AHI 1.4, oxygen nadir 89%, and maximum transcutaneous CO2 level of 47 mmHg. Her dysphagia and residual mild intermittent snoring are improving with no signs of recurrence of the mass. Conclusion Upper airway obstruction secondary to neck mass in pediatric patients is rare and even less commonly found to be recurrent ganglioneuroma. This case offers further understanding of the complexities of diagnosing and treating insidiously growing retropharyngeal tumors and the prompt management of critically obstructed airways. Support (if any)

The role of the Notch signalling pathway in regulating the balance between neuronal and nonneuronal cells in sympathetic ganglia and the adrenal gland.

Sympathetic neurons and endocrine chromaffin cells of the adrenal medulla are catecholaminergic cells that derive from the neural crest. According to the classic model, they develop from a common sympathoadrenal (SA) progenitor that has the ability to differentiate into both sympathetic neurons and chromaffin cells depending on signals provided by their final environment. Our previous data revealed that a single premigratory neural crest cell can give rise to both sympathetic neurons and chromaffin cells, indicating that the fate decision between these cell types occurs after delamination. A more recent study demonstrated that at least half of chromaffin cells arise from a later contribution by Schwann cell precursors. Since Notch signalling is known to be implicated in the regulation of cell fate decisions, we investigated the early role of Notch signalling in regulating the development of neuronal and non-neuronal SA cells within sympathetic ganglia and the adrenal gland. To this end, we implemented both gain and loss of function approaches. Electroporation of premigratory neural crest cells with plasmids encoding Notch inhibitors revealed an elevation in the number of SA cells expressing the catecholaminergic enzyme tyrosine-hydroxylase, with a concomitant reduction in the number of cells expressing the glial marker P0 in both sympathetic ganglia and adrenal gland. As expected, gain of Notch function had the opposite effect. Numbers of neuronal and non-neuronal SA cells were affected differently by Notch inhibition depending on the time of its onset. Together our data show that Notch signalling can regulate the ratio of glial cells, neuronal SA cells and nonneuronal SA cells in both sympathetic ganglia and the adrenal gland.

Satellite glia modulate sympathetic neuron survival, activity, and autonomic function

Satellite glia are the major glial cells in sympathetic ganglia, enveloping neuronal cell bodies. Despite this intimate association, the extent to which sympathetic functions are influenced by satellite glia in vivo remains unclear. Here, we show that satellite glia are critical for metabolism, survival, and activity of sympathetic neurons and modulate autonomic behaviors in mice. Adult ablation of satellite glia results in impaired mTOR signaling, soma atrophy, reduced noradrenergic enzymes, and loss of sympathetic neurons. However, persisting neurons have elevated activity, and satellite glia-ablated mice show increased pupil dilation and heart rate, indicative of enhanced sympathetic tone. Satellite glia-specific deletion of Kir4.1, an inward-rectifying potassium channel, largely recapitulates the cellular defects observed in glia-ablated mice, suggesting that satellite glia act in part via K+-dependent mechanisms. These findings highlight neuron-satellite glia as functional units in regulating sympathetic output, with implications for disorders linked to sympathetic hyper-activity such as cardiovascular disease and hypertension.

Massive ganglioneuroma of the parapharyngeal space in a pediatric patient: a case report

BackgroundNeuroblastic tumors arise from primitive sympathetic ganglion cells and are the most common extracranial solid tumor of childhood. Ganglioneuroma is the most well-differentiated, benign subtype and comprises less than 1% of all soft tissue tumors. One to 5% of these occur in the head and neck, including the parapharyngeal space. It is uncommon to find a physically detectable, neoplastic parapharyngeal space mass in a child.Case reportA 7-year-old boy presented with a painless left neck mass. Imaging revealed a 2.6 × 2.7 × 6.1 cm left parapharyngeal space mass. Fine-needle aspiration suggested a ganglioneuroma. The patient developed compressive symptoms, notably pain, thus the decision was made to surgically resect. The tumor was excised transcervically, preserving the great vessels, phrenic and cranial nerves. Postoperatively, the patient developed a mild ipsilateral Horner’s syndrome, suggesting the mass to be a ganglioneuroma of the sympathetic chain.ConclusionsCervical ganglioneuromas typically present as slow-growing masses that cause compressive symptoms or are found incidentally. Resection is reserved for those with significant symptoms and is often complicated by Horner’s syndrome. In the review of literature, there are 23 reported cases of ganglioneuroma in the head/neck with a median age of 17 years. Eight of these occurred in the para/retropharyngeal spaces. Of these, five presented as an asymptomatic neck mass, two presented with compressive symptoms, and one was discovered incidentally. It is important to consider ganglioneuroma in the workup of pediatric neck masses, even in young children. Asymptomatic masses should be monitored for symptomatic transformation, and excision should be considered.

Adrenal Ganglioneuroma: Case Report and Literature Review

Introduction: Ganglioneuroma is a rare, benign neurogenic tumor that develops from sympathetic ganglionic cells. It is mainly located in the retroperitoneal region. Observation: This is a 39-year-old patient with no pathological history who has been seen for right back pain. Abdominal CT showed a right adrenal tumor with diameters of 40mm×22.5mm, a spontaneous density of >10 HU before injection, and > 31.5 HU after injection with a wash-out at late time < 40%. The hormonal balance reversed the secreting character of the mass, surgical treatment was indicated, histological analysis came back in favor of adrenal ganglioneuroma. Conclusion: Although benign, the ganglioneuroma may present malignant aspects, including scanographic that can mislead the clinician. Therefore, histology remains the examination of choice to make the diagnosis.

Comparison of two Schwann Cell-Containing Orbital Tumors: Schwannoma and Ganglioneuroma.

Orbital tumors comprise a variety of diseases, although tumors of the peripheral nerves are rare. Of these, schwannoma is considered the most common entity, consisting histopathologically almost exclusively of Schwann cells. Another benign tumor containing Schwann cells is ganglioneuroma. Here, ganglion cells are histopathologically apparent in addition to the Schwann cell-containing stroma. Ganglioneuroma belongs to the group of neuroblastic tumors and can occur anywhere in the pathway of sympathetic ganglion cells. In this report, we present the disease courses as well as the findings of two patients with different orbital tumors. In both cases, the diagnosis was only confirmed by histopathological examination. The first patient had a schwannoma with cystic degeneration and the second patient had a ganglioneuroma, both tumor entities which occur only rarely in the orbit. Commonalities and differences are discussed.

BET and CDK Inhibition Reveal Differences in the Proliferation Control of Sympathetic Ganglion Neuroblasts and Adrenal Chromaffin Cells.

Simple SummaryNeuroblastoma is a childhood tumor of the sympathetic nervous system. Abdominal tumors that arise in the adrenal differ genetically and clinically from tumors that develop from sympathetic ganglia. Adrenal chromaffin cells and ganglionic neuroblasts are derived from different lineages, raising the possibility that their diverse tumor characteristics are due to different tumor founder cells. To identify traits that are specific to the candidate founder cells of adrenal and ganglionic tumors, cultures of mouse chromaffin cells and sympathetic neuroblasts were treated with a panel of proliferation inhibitors that affect various signaling pathways. Transcription-related inhibitors (BET, CDK7/12/13) showed differential effects, indicating that the BET protein and CDK signaling pathways differ in their relevance for proliferating chromaffin cells and sympathetic neuroblasts. Thus, the oncogenic aberrations affecting these pathways should differ in their efficiency and result in selective propagation, which may lead to adrenal and ganglionic tumors having different characteristics.Neuroblastoma arising from the adrenal differ from ganglionic neuroblastoma both genetically and clinically, with adrenal tumors being associated with a more severe prognosis. The different tumor properties may be linked to specific tumor founder cells in adrenal and sympathetic ganglia. To address this question, we first set up cultures of mouse sympathetic neuroblasts and adrenal chromaffin cells. These cultures were then treated with various proliferation inhibitors to identify lineage-specific responses. We show that neuroblast and chromaffin cell proliferation was affected by WNT, ALK, IGF1, and PRC2/EZH2 signaling inhibitors to a similar extent. However, differential effects were observed in response to bromodomain and extraterminal (BET) protein inhibitors (JQ1, GSK1324726A) and to the CDK-7 inhibitor THZ1, with BET inhibitors preferentially affecting chromaffin cells, and THZ1 preferentially affecting neuroblasts. The differential dependence of chromaffin cells and neuroblasts on BET and CDK signaling may indicate different mechanisms during tumor initiation in sympathetic ganglia and adrenal.

Microscopic structure of the ganglia of the solar plexus and other ganglia of the marginal trunk of the sympathetic nerve

In my work on the fine structure of the intracardiac nervous system of mammals (Proceedings of the Society of Russian Doctors in St. Petersburg for 1907), I proposed a new classification of sympathetic ganglion cells, based on the principle that a given cell belonged to one type or another, depending on whether what type of terminal apparatuses end its dendrites. In this work, I have described in more or less detail four of these main types of ganglion cells, and a large number of drawings taken from the corresponding preparations are attached to the German text of this work (Internat. Monatsschrift fr Anatomie und Physiologie. Bd. XXV. 1908).

Transplantation for ultra high-risk neuroblastoma patients: effect of tandem autologous stem cell transplantation

Aim: Neuroblastoma is a tumor with a high mortality rate originating from primitive sympathetic ganglion cells. In recent years, the definition of "ultra high-risk" has been used, in which the response to treatment is added in addition to the disease characteristics. In this study, the results of tandem high-dose Iodine 131 (131I) metaiodobenzylguanidine (MIBG) and tandem autologous hematopoietic stem cell transplantation (HSCT) in patients who were diagnosed as refractory after first-line treatments and considered with ultra-high risk nöroblastom (NBL) in Erciyes University Medical Faculty Pediatric Bone Marrow Transplant Center were shared.
 Material and Method: Eleven patients who underwent tandem MIBG and autologous HSCT with the diagnosis of refractory/ultra high-risk NBL between 2011 and 2021 were included in the study. Patient's data were obtained retrospectively using an electronic or manuscript medical record.
 Results: Tandem autologous HSCT and MIBG treatment were applied to 11 patients with a median age of 40.5 months who were diagnosed with refractory/ultra high-risk neuroblastoma. In our study, the overall survival rate was 54.5% and event-free survival (EFS) was 39% at a median follow-up of 20.7 (7.8-105.6) months. Of the 6 surviving patients, 4 are followed in complete remission and 2 in partial remission.
 Conclusion: Our study is the only study that includes a group of patients who received tandem high-dose MIBG and tandem autologous HSCT transplantation in refractory NBL patients without cytokine and immunotherapy. Tandem transplantation and MIBG therapy in ultra-high-risk NBL cases remain promising with acceptable toxicity. Adding immunotherapy to this treatment protocol and combining it with new treatment modalities such as anaplastic lymphoma kinase (ALK), which also takes into account genetic characteristics, may increase survival and event-free survival rates.

Chronic Diarrhea and Weight Loss in an 18-month-old Boy.

Chronic Diarrhea and Weight Loss in an 18-month-old Boy.

Ocular Health of Octodon degus as a Clinical Marker for Age-Related and Age-Independent Neurodegeneration

The aging process and age-related diseases such as Alzheimer’s disease (AD), are very heterogeneous and multifactorial, making it challenging to diagnose the disease based solely on genetic, behavioral tests, or clinical history. It is yet to be explained what ophthalmological tests relate specifically to aging and AD. To this end, we have selected the common degu (Octodon degus) as a model for aging which develops AD-like signs to conduct ophthalmological screening methods that could be clinical markers of aging and AD. We investigated ocular health using ophthalmoscopy, fundus photography, intraocular pressure (IOP), and pupillary light reflex (PLR). The results showed significant presence of cataracts in adult degus and IOP was also found to increase significantly with advancing age. Age had a significant effect on the maximum pupil constriction but other pupil parameters changed in an age-independent manner (PIPR retention index, resting pupil size, constriction velocity, redilation plateau). We concluded that degus have underlying factors at play that regulate PLR and may be connected to sympathetic, parasympathetic, and melanopsin retinal ganglion cell (ipRGC) deterioration. This study provides the basis for the use of ocular tests as screening methods for the aging process and monitoring of neurodegeneration in non-invasive ways.

A Rare Case of Diffuse Intestinal Ganglioneuromatosis in a Child Presenting with Intussusception

Ganglioneuromas are benign neurogenic neoplasms commonly seen in children which are originating from neural crest cells of sympathetic ganglia or adrenal medulla. Rarely, they may arise from the visceral organs like intestine. Diffuse intestinal ganglioneuromatosis is a rare disease, caused due to abnormal proliferation of ganglion cells, nerve fibres and schwann cells in the wall of intestine. Author hereby present a case of diffuse intestinal ganglioneuromatosis in an 18-month-old male child who presented with symptoms of small bowel obstruction. Resected segment of ileocecal junction revealed ulcero-nodular areas which on microscopy showed diffuse hyperplasia of nerve bundles and ganglion cells with immunohistochemistry confirmation. Intestinal ganglioneuromatosis is a rare condition having syndromic association with MEN-2B, Neurofibromatosis-1 and Cowden syndrome. As this disease has a low clinical suspicion, very nonspecific symptoms and radiological findings, histopathological examination becomes mainstay in diagnosis. Further workup is essential to rule out presence of associated syndromes.Surgical excision is the ultimate treatment with screening for genetic abnormalities.

S1663 The Nerves of the Colon

INTRODUCTION: Ganglioneuromas are benign, rare and slow growing tumors that typically begin growth within sympathetic ganglion cells. Uncommonly, ganglioneuromas can initiate growth within the colon. Our case report details a 72 year-old male presenting with unexplained chronic diarrhea that resulted in an extensive non-invasive work-up, followed by colonoscopy revealing the ultimate diagnosis of colonic ganglioneuroma. CASE DESCRIPTION/METHODS: 72 year-old male with a past medical history of hypertension and hypothyroidism presented to the clinic with complaints of chronic diarrhea. The patient reported years of chronic non-bloody loose stools, 3-4 times per day with associated urgency and lower abdominal cramps. Symptoms were relieved after defecation. The patient had attempted loperamide, probiotics and multiple dietary modifications without improvement. Last colonoscopy for colorectal screening was three years prior yielding grade II internal hemorrhoids and one single tubular adenoma. On presentation, the patient was afebrile with normal vital signs and benign physical exam. He underwent an extensive workup for chronic diarrhea including complete blood count and metabolic panel, ESR, CRP, TSH, stool C. diff toxin gene PCR, ova and parasite, giardia and cryptosporidium antibodies, celiac panel, lactoferrin, ANCA, proteinase3 antibody, myeloperoxidase antibody, fecal fat and HIV screening; all within normal limits. The patient subsequently underwent colonoscopy with findings of a 20 mm flat polyp in the ascending colon with histology findings of positive S-100 immunostain; negative for CD117 and CD34 immunostain, consistent with ganglioneuroma. DISCUSSION: Ganglioneuromas most commonly arise within the head and neck area or adrenal glands and are rarely found within the gastrointestinal (GI) tract. When in the GI tract, ganglioneuromas may present in three forms: isolated polyp (polypoid), multiple polyps (ganglioneuromatous polyposis) or diffuse polyps of the bowel wall (intestinal ganglioneuromatosis). Current treatment for solitary ganglioneuromatous polyps is resection, which is curative and offers a favorable prognosis; with almost no change in clinical mortality. No current guidelines exist for surveillance of recurrence. For cases with multiple polyps or diffuse bowel wall involvement, genetic screening may be indicated to screen for associated syndromes, such as neurofibromatosis 1, MEN 2B, NFAP or Cowden’s disease.Figure 1.: A 15 mm polypoid lesion was found in the proximal descending colon. The lesion was sessile. No bleeding was present. This was biopsied with a cold forceps for histology.Figure 2.: Hematoxylin an eosin staining showed spindle-cell proliferation in submucosa that shows S100 immunoreactivity.Figure 3.: A few ganglion cell shows synaptophysin immunoreactivity.

Role and toxicity of radiation therapy in neuroblastoma patients: A literature review.

Neuroblastoma is the most common extracranial solid tumor, arising from primitive sympathetic ganglion cells, in pediatric patients. The unique features of neuroblastoma include variable clinical behaviors, such as rapid progression to death and maturation to benign ganglioneuroma, followed by regression. Radiation therapy (RT) is usually administered to both the primary tumor bed and persistent metastatic sites after induction chemotherapy for high-risk neuroblastoma. RT to the tumor bed after surgical resection contributes significantly to local disease control and prevention of local relapse, confirming the role of RT. Palliative radiotherapy for metastatic neuroblastoma is also effective and safe and mainly provides symptomatic relief. The late side effects of RT in neuroblastoma patients include growth and developmental failure, hypothyroidism, gastrointestinal dysfunction, neurocognitive defects, pulmonary and cardiac abnormalities, infertility, and secondary cancers. In this article, we reviewed the role and toxicity of RT in neuroblastoma patients.