Disclosures: Jay Darji, DO:

Case Diagnosis: Femoral nerve ganglioneuroma causing femoral neuropathy

Case Description: A 77-year-old female with a history of lumbar stenosis and radiculopathy status-post L1-3 right hemilaminectomy and foraminotomy one year prior presented to her spine surgeon with constant, severe right lower extremity (RLE) pain radiating from the right lateral thigh to the dorsum of the right foot. The pain was worse at night and with activity and characterized as “electrical and shooting”. No bowel/bladder dysfunction nor saddle anesthesia was noted. The patient had weakness throughout the RLE but intact sensation. Conservative care failed to improve her pain. A pelvic MRI showed a T2 hyperintense lesion along the right iliacus muscle that was biopsied and revealed a femoral nerve sheath ganglioneuroma.

Discussion: Ganglioneuromas are rare, benign tumors that arise from mature sympathetic ganglion cells. They typically occur along the sympathetic chain in the mediastinum, retroperitoneum, and adrenal glands. The location of this patient’s tumor caused significant neuropathic pain, but targeted nerve injections provided minimal relief. The stimulation generated by the electrodes in SCS are thought to alter pain signal pathways and can span multiple nerve root levels.

Setting: Academic Multidisciplinary Spine ClinicAssessment/

Results: Case was discussed at Tumor Board Review and given increased risk of permanent quadriceps weakness with surgery, the patient elected conservative management. She required hydromorphone for pain control in the interim. She underwent one selective nerve root block and two lumbar epidural steroid injections without significant relief. She ultimately agreed to a trial of paresthesia-free thoracolumbar dorsal column stimulation and subsequently reported 75-80% improvement in pain and sleep quality with reduced narcotic use.

Conclusion: Ganglioneuromas are a rare cause of femoral neuropathy and given the significant risk associated with surgical resection, SCS implantation may be considered as an alternative treatment.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/thoracolumbar-dorsal-column-stimulation-for-femoral-nerve-sheath-tumor-a-case-report/