[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-450944-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-450944-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","resection-of-bilateral-dumbbell-c2-ganglioneuroma-surgical-technique","Resection of bilateral dumbbell C2 ganglioneuroma - Surgical Technique","","Ganglioneuroma is a rare neural crest–derived benign pathology that commonly occurs outside the spine, with weakness, gait disturbance, and back pain as frequent symptoms. It is often linked to neurofibromatosis type 1 and typically affects younger women with a mean age around 40 years. A video resection is reported for a bilateral C2 “dumbbell” ganglioneuroma in an 83-year-old male presenting with symptomatic cervical myelopathy, including progressive upper-extremity weakness and bladder incontinence. Imaging showed bilateral C2 nerve sheath lesions causing canal stenosis, marked cord compression, cord edema, and myelomalacia; urgent complete excision led to symptom resolution at follow-up.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/resection-of-bilateral-dumbbell-c2-ganglioneuroma-surgical-technique/450944/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/resection-of-bilateral-dumbbell-c2-ganglioneuroma-surgical-technique/450944.png","ImageObject",300,407,{"name":42,"@type":43},"Bintang","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-02","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What symptoms and neurologic deficits did the 83-year-old patient have before surgery?","Question",{"text":63,"@type":64},"He had progressive intermittent neck pain, bilateral upper-extremity numbness, difficulty with fine motor tasks, bladder urgency, gait instability, and upper-extremity weakness with preserved lower-extremity strength. Physical exam also showed wide-based gait and inability to tandem step, with bilateral Hoffman’s reflexes.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How did imaging findings support the diagnosis and surgical urgency?",{"text":68,"@type":64},"Preoperative MRI demonstrated two distinct non-enhancing bilateral C1–C2 lesions with significant mass effect that appeared intradural and involved nerve roots. The findings included canal stenosis and significant spinal cord compression bilaterally with cord edema and myelomalacia changes, indicating risk of irreversible injury.",{"name":70,"@type":61,"acceptedAnswer":71},"What treatment approach was used, and what was the reported outcome?",{"text":72,"@type":64},"The patient underwent complete surgical excision of the bilateral C2 dumbbell ganglioneuromas using an operative strategy aimed at full symptom resolution. Follow-up showed resolution of symptoms, supporting the approach for similar presentations in older patients.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},450944,1790765257,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":102,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},962085564381,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Surgical Technique  \nResection of bilateral dumbbell C2 ganglioneuroma  \nNicholas Dietz, Aashka Sheth, Thomas Altstadt  \nDepartment of Neurosurgery, University of Louisville, Louisville, KY, USA  \nContributions: (I) Conception and design: N Dietz, T Altstadt; (II) Administrative support: N Dietz, T Altstadt; (III) Provision of study materials or patients: N Dietz, T Altstadt; (IV) Collection and assembly of data: N Dietz, T Altstadt; (V) Data analysis and interpretation: N Dietz, T Altstadt; (VI)  \nManuscript writing: All authors; (VII) Final approval of manuscript: All authors.  \nCorrespondence to: Nicholas Dietz, MD. Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Way, Louisville, KY 40202, [USA. Email: nkd25@georgetown.edu](USA. Email: nkd25@georgetown.edu).  \nAbstract: Ganglioneuroma is a rare pathology of neural crest lineage that typically presents outside the spine, with common symptoms including weakness, gait disorder, and back pain. This condition is frequently associated with neurofibromatosis 1 and typically presents in younger female patients with a mean age of  \n40 years. We report a video resection of bilateral C2 “dumbbell” ganglioneuroma in an older male patient with symptomatic cervical myelopathy. The patient is an 83-year-old male with several months of progressive symptoms of cervical myelopathy including upper extremity weakness and bladder incontinence. His imaging was remarkable for bilateral C2 nerve sheath lesions with canal stenosis and significant cord compression bilaterally, resulting in cord edema and myelomalacia changes. To our knowledge, a case of bilateral cervical ganglioneuroma with myelopathic symptoms in a patient aged 80 years has not been previously reported in the literature. Older patients with myelopathic symptoms must be managed urgently to prevent irreversible spinal cord injury. Our patient was successfully managed with complete surgical excision of the tumors, and resolution of symptoms was seen at follow-up, representing a successful treatment paradigm for similar cases.  \nKeywords: Ganglioneuroma; dumbbell cervical lesions; intradural resection; microsurgery  \nSubmitted Aug 10, 2025. Accepted for publication Oct 22, 2025. Published online Dec 19, 2025.  \ndoi: 10.21037/jss-25-147  \nView this article at: [https://dx.doi.org/10.21037/jss-25-147](https://dx.doi.org/10.21037/jss-25-147)  \nIntroduction  \nGanglioneuroma is a rare benign tumor derived from neural crest lineage (1) with only 10% found in the spine, typically presenting in younger female patients with a mean age of 40 years (2,3) . Most common symptoms include weakness of extremities, gait disorder, and lower back pain with radiculopathy (1) . Total surgical excision is recommended to reduce the recurrence risk (4). If total excision is not possible due to size or location, partial resection is an acceptable management option. In cases of partial resection, further chemotherapy or radiation is usually not necessary (4) . Most ganglioneuroma presentations are solitary and unilateral, but may rarely occur bilaterally, resulting in spinal cord compression (5) . We present an unusual case of bilateral C2 ganglioneuroma in a male octogenarian  \nwith severe cervical myelopathy. Given the evidence of cervical myelopathy and high risk of future progression to spinal cord injury, the patient was managed operatively via tumor excision with the intent of full symptom resolution. We present this article in accordance with the SUPER reporting checklist (available at [https://jss.amegroups.com/](https://jss.amegroups.com/)[ ](https://jss.amegroups.com/)[article/view/10.21037/jss-25-147/rc](article/view/10.21037/jss-25-147/rc)) .  \nPreoperative preparation and requirements  \nThis procedure was performed in a surgical suite at an academic hospital. The surgical team consisted of an attending neurosurgeon, a resident neurosurgeon, anda surgical technician. Special instruments used included Gardner-Wells tongs, J","cbCaielETICizLXR","https://ap.wps.com/l/cbCaielETICizLXR","pdf",1549027,"English","# Introduction\n## Preoperative preparation and requirements\n## Operative details and highlighted key findings\n## What is conventional and what is novel/modified?","[{\"question\":\"What symptoms and neurologic deficits did the 83-year-old patient have before surgery?\",\"answer\":\"He had progressive intermittent neck pain, bilateral upper-extremity numbness, difficulty with fine motor tasks, bladder urgency, gait instability, and upper-extremity weakness with preserved lower-extremity strength. Physical exam also showed wide-based gait and inability to tandem step, with bilateral Hoffman’s reflexes.\"},{\"question\":\"How did imaging findings support the diagnosis and surgical urgency?\",\"answer\":\"Preoperative MRI demonstrated two distinct non-enhancing bilateral C1–C2 lesions with significant mass effect that appeared intradural and involved nerve roots. The findings included canal stenosis and significant spinal cord compression bilaterally with cord edema and myelomalacia changes, indicating risk of irreversible injury.\"},{\"question\":\"What treatment approach was used, and what was the reported outcome?\",\"answer\":\"The patient underwent complete surgical excision of the bilateral C2 dumbbell ganglioneuromas using an operative strategy aimed at full symptom resolution. Follow-up showed resolution of symptoms, supporting the approach for similar presentations in older patients.\"}]","Resection of bilateral dumbbell C2 ganglioneuroma - Surgical Technique | PDF",1790734111,15]