Resection of bilateral dumbbell C2 ganglioneuroma

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 40 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.