title: Symmetric dumbbell ganglioneuromas of bilateral C2 and C3 roots with intradural extension associated with von Recklinghausen's disease: case report.
abstract: BACKGROUND
  Ganglioneuromas are rare benign tumors arising most commonly from the sympathetic nervous system. They occasionally grow in a dumbbell fashion extending into the spinal canal extradurally. However, ganglioneuromas of the cervical spine with intradural extension or multiple locations or in association with von Recklinghausen's disease are rare.
  
  
  METHODS
  A 35-year-old man with von Recklinghausen's disease presented with tetraparesis and respiratory dysfunction. Preoperative neuroimaging revealed an intradural mass extending from the foramen magnum to the C4 vertebral level, as well as bilateral extravertebral extension connecting it with bilateral paraspinal lesions in a dumbbell fashion. Four intradural tumors associated with the bilateral C2 and C3 nerves and located ventrally were removed, leaving the intraforaminal and extradural portion intact. The procedure resulted in postoperative symptomatic improvement. Second, extravertebral tumors of the left neck, which were not related to the cervical sympathetic nerve, were removed. The pathologic diagnosis of the tumors of both the intradural space and cervical neck was ganglioneuroma.
  
  
  CONCLUSIONS
  We present an extremely rare case in an adult with von Recklinghausen's disease who had bilateral, symmetric and multiple dumbbell ganglioneuromas with intradural extension, and also multiple bilateral ganglioneuromas at the neck. The intradural ganglioneuromas were suspected to have originated from the posterior root ganglions of the bilateral C2 and C3 nerves and to have extended ventrally to the spinal cord involving not only sensory but also motor rootlets; the ganglioneuroma of the neck was suspected to have originated from the cervical nerve itself.
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kyoshima
authors.forename: Keiichi
authors.initials: K
authors.lastname: Sakai
authors.forename: Miki
authors.initials: M
authors.lastname: Kanaji
authors.forename: Susumu
authors.initials: S
authors.lastname: Oikawa
authors.forename: Sumio
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sato
authors.forename: Jun
authors.initials: J
authors.lastname: Nakayama
mesh_terms: D000328:Adult; D003399:Craniotomy; D005729:Ganglioneuroma / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D007796:Laminectomy; D008297:Male; D009333:Neck; D009361:Neoplasm Invasiveness; D009456:Neurofibromatosis 1 / Q000150:complications* / Q000175:diagnosis*; D010524:Peripheral Nervous System Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D011182:Postoperative Care; D011300:Preoperative Care; D013120:Spinal Cord Neoplasms / Q000150:complications* / Q000175:diagnosis*; D013126:Spinal Nerve Roots / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed