BACKGROUND: Presacral ganglioneuromas are extremely rare tumors, with only 37 documented cases in the literature. For a successful outcome, resection is crucial because it is currently the only effective treatment option. With the advancement in resection techniques, robotic surgery is now being utilized for achieving optimal surgical outcomes, with only 2 previous cases being documented in the literature for the resection of presacral ganglioneuroma. Since ganglioneuromas are benign, radiation therapy and adjuvant chemotherapy are not recommended; however, frequent monitoring is required to detect possible local recurrences early. OBSERVATIONS: The authors present the case of presacral ganglioneuroma in a 62-year-old male who underwent robot-assisted excision. Robot-assisted surgery allowed for a positive surgical outcome, including the absence of intra- or postoperative complications and a decreased length of hospital stay. LESSONS: The presacral location poses challenges to resection due to many exiting nerve roots. Robotic surgery facilitates positive patient outcomes for tumors in challenging anatomical locations like the presacral location. https://thejns.org/doi/10.3171/CASE25462.
Hariharan et al. (2026) studied this question.