Clinical manifestation and surgical treatment of ganglioneuroma of cervical spine

English Keywords:Ganglioneuroma  Cervical spine  Spine tumor  Microsurgery

English Abstract:

  【Abstract】 Objective：To investigate the clinical manifestation and surgical outcome of ganglioneuroma of cervical spine.Method：From June 2001 to July 2007，10 patients with cervical spine ganglioneuromas treated surgically were analyzed retrospectively.There were 5 males and 5 females with an average age of 45.1 years（range，28-65 years）.Clinically，6 patients presented with radicular neuralgia，and 4 patients with motor deficit below the mass level，3 patients showed sensory deficit below the lesion on physical examination.MRI revealed low density signal on T1 weighted，and high density signal on T2 weighted images with apparent intensification.3 cases had lesion in the space of extramedullary-subdural/epidural and 2 of them presented as dumbbell shaped across neural foramen.7 cases had tumors sited in extradural and across neural foramen.4 tumors located at the level of C1-C2，1 at C3-C4，1 at C4-C5，3 at C5-C6 and 1 at C4-C6.The surgical protocols included hemilaminectomy and facetactomy in 8 dumbbell shaped tumors which occupied the most neural foramen region，and conventional laminectomy in 2 cases which occupied the dural sac alone.Posterolateral procedures were performed in 2 cases for removal of the para-spinal part of dumbbell shaped tumor due to their extensive involvement.All tumors were dissected microscopically.Result：10 operations had been performed with 9 en bloc and 1 subtotal resection.Pathological results showed mature or degenarative ganglion cells in neoplastic Schwann stroma，normal spindle shaped cells were evidenced in tumor tissue.CSF leakage was noted in 2 patients.4 of 6 patients with neuralgia prior operation achieved pain relief while the others remained no change.Among the 4 patients with four limbs motor deficit prior operation，3 patients improved and 1 patient remained no change.The follow-up ranged from 2.1 year to 7.2 years（average，4.1 years）.8 patients had neurological function improved and 2 remained no change which was evaluated by McCormick scale for spinal function status at final follow-up.During the follow-up，only 1 patient experienced tumor recurrence at the same site 2 years later which was removed after reoperation.Conclusion：Cervical spine ganglioneuroma presents with chronic radicular neuralgia，sensory and motor deficit.The tumor presenting as dumbbell shaped across neural foramen mostly sites in the extradural space.Surgical excision en bloc is reliable.