Posterior Approach for Microsurgical Resection of a Ventrolateral Cervical Ganglioneuroma: an Illustrative Case and Technical Report

Summary

This protocol describes posterior midline cervical laminectomy with laminoplasty reconstruction and microsurgical resection of a ventrolateral intradural extramedullary ganglioneuroma in a pediatric patient, providing a reproducible surgical framework for this rare tumor.

Abstract

Ganglioneuromas of the cervical spine are exceptionally rare, well-differentiated neuroblastic tumors. We present the case of a 4-year-old female with a several-month history of progressive fatigue, right upper extremity weakness, and gait instability, in whom MRI demonstrated a homogeneously enhancing, cervical intradural extramedullary mass causing significant ventral spinal cord compression. A posterior midline approach with cervical two to cervical six laminoplasty was performed under continuous neurophysiological monitoring, providing wide dorsal access to the lesion. Microsurgical resection of the ventrolateral mass was accomplished using careful arachnoid dissection and cerebrospinal fluid drainage to achieve gross total resection, with histopathology confirming mature ganglioneuroma without malignant transformation. A postoperative MRI demonstrated gross total resection of the mass. At the 6-month follow-up, the patient has demonstrated marked neurological recovery, with full upper extremity strength and normal gait. This case offers a reproducible procedural framework for ventrolateral intradural cervical tumors in the pediatric population while underscoring the importance of multidisciplinary planning, laminoplasty-based posterior corridor selection, and meticulous microsurgical technique.

Introduction

Ganglioneuromas are well-differentiated, benign neuroblastic tumors arising from mature ganglion cells and Schwann cells of the sympathetic nervous system. They represent the most mature end of the neuroblastic tumor spectrum, which also includes neuroblastoma and ganglioneuroblastoma. Intraspinal ganglioneuromas are rare, accounting for fewer than 1% of all spinal tumors, and cervical involvement is exceptionally uncommon. Most reported cases occur in adults, making the pediatric presentation described here particularly unusual^1,2.

The goal of the present method is to demonstrate a....

Protocol

This protocol follows the Institutional Review Board guidelines of Dell Children's Medical Center and complies with the principles of the Declaration of Helsinki. Informed consent was obtained from the patient's parents for publication of this case.

1. Preoperative planning and multidisciplinary evaluation

1. Document a detailed history and baseline neurological examination.
2. Obtain high-resolution magnetic resonance imaging (MRI) of the entire spine with and without gadolinium contrast to characterize the tumor's signal characteristics, extent of involvement, and degree of spinal cord compress....

Results

This protocol was executed successfully in a 4-year-old female with a several-month history of progressive fatigue, right upper extremity weakness, and gait instability. Her strength exam was notable for right triceps, grip, and bilateral dorsiflexion and plantarflexion equal to 4/5 on the Medical Research Council (MRC) scale. Her MRI demonstrated a homogeneously enhancing, cervical intradural extramedullary mass causing significant ventral spinal cord compression (Figure 1). A posterior mid.......

Discussion

This protocol and representative case offer a guide for a posterior approach to ventrolateral IDEM cervical tumors in the pediatric population, while underscoring the importance of multidisciplinary planning, laminoplasty-based selection of the posterior corridor, and meticulous microsurgical technique. Approach selection for IDEM cervical tumors must be guided by the tumor's dominant location on axial imaging. For tumors with a ventrolateral epicenter or foraminal extension (as in the present case), the posterior ap.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
BK Ultrasound	GE Healthcare	2300-61	Intraoperative ultrasound used to visualize lesion prior to and after resection
Mayfield Skull Clamp	Integra LifeSciences	A1114	Cranial fixation system for positioning patient
Operative Microscope	Leica	M530 OHX	Intraoperative microscope used for resection of lesion
Sonopet iQ	Stryker	5500-050-000	Ultrasound aspirator used for en bloc laminectomy and lesion debulking
Universal Neuro III	Stryker	53-34804	Titanium plates and screws used for laminoplasty