title: Ganglioneuroma: to operate or not to operate.
abstract: BACKGROUND
  Ganglioneuroma (GN) is a benign, differentiated variety of neurogenic tumor. It is often asymptomatic and may be diagnosed by serendipity. Surgical removal is the treatment of choice. However, it has been suggested that postoperative complications and sequelae might outweigh the benefits of this approach. The purpose of the present study was to examine these issues in a large experience of neural tumors.
  
  
  METHODS
  Patients treated between 1992 and 2012 were retrospectively reviewed. Modern imaging, measurement of catecholamine metabolite excretion and metaiodobenzylguanidine were used for workup. Surgical treatment aimed at complete resection. Complications and sequelae were recorded. Literature was searched for regrowth or malignant transformation of GN.
  
  
  RESULTS
  Of 227 patients with neural tumors, 24 were GN patients (12 abdominal, 11 thoracic and 1 cervical with 8 dumbbell extensions). Six children were symptomatic (three with abdominal pain and mass, one with stridor or dysphonia, and one each with anisocoria and opsomyoclonus). However, 18 (75%) were asymptomatic and the diagnosis was incidental. Several tumors were large and involved more than one body space. There were no neurologic symptoms in eight cases with dumbbell extension. Complete resection was achieved in 20 children (83%) whereas gross residual was left in four. Postoperative complications were: Horner syndrome (3 patients), mild scoliosis (1 patient), adhesive bowel obstruction (1 patient) and acute urinary retention (1 patient). There was no evidence of either regrowth or malignant behavior in residual masses left in place after follow-up of 84 (1-194) months.
  
  
  CONCLUSIONS
  There were a limited number of general minor complications in this series that did not include cases of regrowth or malignant transformation. However, these unfavorable events were occasionally reported in the literature. Since diagnosis of GN cannot be ascertained before removal of the mass, this should remain the aim of the treatment, although limiting the chances of complications to a minimum even if incomplete resection is the price to pay. Nonoperative attitudes should not be recommended in all cases, but they are certainly justified in some.
authors: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors: Alba
authors: A
authors: Sánchez-Galán
authors: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors: Saturnino
authors: S
authors: Barrena
authors: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors: Alejandra
authors: A
authors: Vilanova-Sánchez
authors: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors: Sara Hernández A
authors: SH
authors: Martín
authors: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors: Sergio
authors: S
authors: Lopez-Fernandez
authors: Department of Pediatric Oncology, Hospital Universitario La Paz, Madrid, Spain.
authors: Purificación
authors: P
authors: García
authors: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors: Manuel
authors: M
authors: Lopez-Santamaria
authors: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors: Leopoldo
authors: L
authors: Martínez
authors: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors: Juan A
authors: JA
authors: Tovar
mesh_terms: D000008:Abdominal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D002423:Cause of Death; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005729:Ganglioneuroma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007558:Italy; D008279:Magnetic Resonance Imaging; D008297:Male; D018365:Neoplasm, Residual / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013899:Thoracic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*