Management of conus medullaris D11-L2 paraganglioma – Case report and literature review

Background: Spinal paragangliomas are rare neuroendocrine tumors arising in the intradural compartment. They are most commonly found in the cauda equina and filum terminale. The diagnosis may be challenging because of nonspecific imaging findings, while their surgical management is marked with increased risk due to their extensive vascularity. Case Description: A 58-year-old male presented with progressive paraparesis and acute urinary retention. The thoracolumbar magnetic resonance (MR) revealed an extensive intradural lesion extending from D11 to L2, centered on the conus medullaris, in conjunction with prominent flow voids suggesting marked hypervascularity. The patient underwent a laminectomy, and intraoperatively, the tumor was highly vascular and tightly adherent to the conus medullaris; severe bleeding led to hemodynamic instability requiring transfusion. Only subtotal resection was feasible. Histopathological and immunohistochemical findings confirmed the diagnosis of a paraganglioma. The patient subsequently received adjuvant external beam radiotherapy (45 Gy) and physiotherapy, and he eventually completely recovered. Conclusion: Conus medullaris paraganglioma is a rare, extremely hypervascular conus spinal tumor diagnosed on MR imaging with characteristic prominent flow voids. Surgical management typically includes subtotal resection (i.e., to maintain neurological function) followed by adjuvant radiotherapy to achieve favorable outcomes.