Surgical management of cervico-mediastinal ganglioneuroma in a child: a case report
Abstract
Background: Cervico-mediastinal ganglioneuroma (GN) is a rare benign neurogenic neoplasm arising from neural crest-derived sympathetic tissue. The tumour may be asymptomatic or may produce symptoms attributable to compression of adjacent cervical and mediastinal structures, including Horner's syndrome. Preoperative diagnosis is challenging owing to overlapping radiological features with other cervicothoracic masses. Complete surgical resection remains the definitive treatment and is associated with an excellent long-term prognosis. Case presentation: We report the case of a 12-year-old girl presenting with a six-year history of a progressively enlarging, painless left laterocervical mass without compressive symptoms. Thoracic CT demonstrated a well-defined, oval, lobulated, predominantly cystic lesion measuring 85 × 55 × 122 mm, extending from the left laterocervical region through the thoracic inlet into the superior mediastinum, with rightward displacement of the tracheooesophageal axis. Preoperative imaging suggested cystic lymphangioma. Under general anaesthesia, complete surgical resection was achieved via an anterior cervico-transsternal approach. The postoperative course was marked by transient unilateral ptosis, which resolved spontaneously. Final histopathological examination confirmed the diagnosis of ganglioneuroma. At three-year follow-up, the patient remains in good general condition with no evidence of recurrence. Conclusion: This case illustrates the diagnostic challenges of cervico-mediastinal GN in the paediatric population and underscores the importance of an appropriately planned surgical approach — including a combined cervico-transsternal access — for achieving complete resection whilst preserving adjacent vascular and neural structures. Transient Horner's syndrome is an expected operative risk and commonly resolves postoperatively. Keywords: ganglioneuroma; cervico-mediastinal; neurogenic tumour; paediatric thoracic surgery; thoracic inlet; cervicotomy; Horner syndrome; case report