Presacral ganglioneuroma: diagnostic considerations and therapeutic strategy

Incidental diagnosis of presacral ganglioneuroma in a patient with hematuria

Ganglioneuromas are benign neuroblastic tumors seen most in pediatric population. The most common locations are mediastinal, retroperitoneal and adrenal regions. Ganglioneuromas rarely occur in presacral space. We present one such case of an incidentally diagnosed presacral ganglioneuroma in an asymptomatic 71-year-old male who initially presented with hematuria.

Presacral ganglioneuroma in an 8-year-old child: case report, and literature review

Ganglioneuromas are benign tumors of the sympathetic nervous system, rarely found in the presacral region. In this study, we report the case of presacral ganglioneuroma in an 8-year-old girl, who complained of abdominal pain with diarrhea and abdominal distension. Ultrasound showed a large hypoechoic pelvic mass complicated by right ureter hydronephrosis. the CT and MRI confirm the presence of a presacral tissue mass with heterogeneous enhancement after contrast injection. The child underwent a complete surgical resection, and the anatomopathological study returned in favor of a ganglioneuroma. The presacral ganglioneuroma is an extremely rare tumor in that only twenty cases have been reported in the literature. 3 of which were less than 8-years-old. Through our case, we will review the epidemiological, clinical, radiological and therapeutic characteristics of this type of tumor.

Intraoperative Nerve Monitoring in Robotic-Assisted Resection Of Presacral Ganglioneuroma: Operative Technique

BACKGROUND

Robotic-assisted techniques have been implemented in the surgical treatment of tumors in the pelvis, abdomen, and thorax. In pelvic tumors, robotic-assisted techniques evade the need for sizable surgical exposure, but make stimulation of the nerves of the sacral plexus very difficult.

OBJECTIVE

To describe how laparoscopic robotic-assisted surgery can couple with tools such as the nerve stimulator to aid in the resection of presacral masses emanating from the neural elements and potentially improve neurological outcome by preventing inadvertent injury to involved nerves.

METHODS

A patient with a large presacral ganglioneuroma underwent resection using the DaVinci system (Intuitive Surgical, Sunnyvale, California) for robotic assistance. A nerve stimulator was coupled to the bipolar cautery instrument of the DaVinci robot to define the presence of functional nerves in the surroundings of the tumor.

RESULTS

By coupling a nerve stimulator to the bipolar cautery instrument of the DaVinci robot (Intuitive Surgical), it was possible to identify important neural structures in close proximity to the tumor. After identifying functional nerves, the surgeon was able to preserve them and preserve neurological function avoiding motor dysfunction.

CONCLUSION

The use of a nerve stimulator coupled to the bipolar cautery instrument of the DaVinci robot (Intuitive Surgical) during laparoscopic, robotic-assisted surgery for resection of presacral masses is safe and feasible. In addition to the preoperative evaluation, intraoperative monitoring and stimulation of nerves in close proximity to the tumor and also exiting through neural foramina involved by the tumor allowed the surgeon to understand the anatomy and preserve neurological function while obtaining optimal surgical resection.

Giant Ganglioneuroma of Thoracic Spine: A Case Report and Review of Literature

Ganglioneuroma (GN) is a rare benign tumor of neural crest origin usually found in the abdomen, but may occasionally present at uncommon sites including the cervical, lumbar, or sacral spine. However, GNs of thoracic spine are extremely rare. In this report, we describe a 12-year-old girl with giant GN in the thoracic spine, who underwent successful resection (T1-4 level) of the tumor. Histopathological examination confirmed the diagnosis. GN should be considered in the differential diagnosis of any paraspinal mass. A high index of suspicion and correlation of clinico-radiological findings is necessary in differentiating a large benign tumor from a malignant growth. Complete surgical excision is the treatment of choice; however tumor size and location need to be considered for the surgical approach (one-step or multiple surgeries). Close follow-up after surgery is mandatory.

Large ganglioneuroma presenting as presacral mass

Ganglioneuromas are benign tumours of the sympathetic nervous system that originate from neural crest cells. They are extremely rare in the presacral region. Here, we report a case of a presacral mass in a 14-year-old female who presented with complaints of pelvic discomfort, difficulty with micturition and constipation. Ultrasonogram showed a large heteroechoic solid mass in the pelvis with bilateral hydroureteronephrosis. It appeared as a well-circumscribed, hypodense mass lesion on CT scan, measuring 14 x 11 x 10 cm. It appeared isointense to muscle on T₁ and heterogeneously hyperintense on T₂ weighted images with heterogeneous post-contrast enhancement on MRI. The lesion was seen in the presacral region displacing the rectum and bladder anteriorly, and extending posteriorly, causing widening of the sacral foramina. The mass was surgically excised and her symptoms resolved. Histopathological examination of the mass revealed features of ganglioneuroma. We report this case in view of the large size of the mass and its rare location.