Cavernous ganglioneuroma of the thoracic spine: surgical nuances and outcomes following limited anterior resection.

backgroundSpinal tumors constitute approximately 15% of all primary central nervous system neoplasms, with extradural tumors accounting for the majority. Ganglioneuromas are rare, benign tumors of neural crest origin, most often located in the posterior mediastinum or retroperitoneum. Involvement of the spinal column from a benign tumor is uncommon and poses significant diagnostic and therapeutic challenges. CASE PRESENTATION: We present the case of 25-year-old woman who was admitted with progressive dyspnea, stridor dysphagia, and chest pain. A thoracic CT and MRI scans revealed a 12 × 8 × 6 cm contrast-enhancing mass in the mid-posterior mediastinum. There was no invasion of adjacent mediastinal structures, except for the destruction of the anterior parts of T2-T3 vertebral bodies. Neurological examination showed preserved motor strength. A multidisciplinary surgical approach involving thoracic and neurosurgical teams was planned. At operation, the anterior, superior and middle mediastinal components of the tumor were initially mobilized via a partial median sternotomy. The tumor was then completely excised alongside a partial corpectomy involving the anterior portions of the T2-T3 vertebrae trough an additional left posterior thoracotomy incision. Despite the anterior portions of the vertebral bodies were partially respected at two levels, the spinal column was not intentionally stabilized. Histopathological evaluation confirmed a cavernous ganglioneuroma. Apart from retention of secretions leading to left lower lobe atelectasis which resolved with intensive chest physiotherapy, the patient made an uneventful recovery and was discharged home on eighth postoperative day. She remains asymptomatic with no evidence of recurrence on thoracic CT imaging at two-year follow-up.

conclusionThis case demonstrates the successful management of a rare spinal cavernous ganglioneuroma via a multidisciplinary surgical approach. Notably, the absence of stabilization following limited anterior column resection did not result in spinal instability or recurrence during the follow-up period. Therefore, we propose that anterior resections involving less than one-third of the vertebral bodies may not require reconstruction of the spinal column in carefully selected cases, although further evidence is needed to validate this observation.