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Peyre M, Tran S, Parfait B, Bernat I, Bielle F, Kalamarides M. Surgical Management of Peripheral Nerve Pathology in Patients With Neurofibromatosis Type 2. Neurosurgery 2023; 92:317-328. [PMID: 36637268 DOI: 10.1227/neu.0000000000002202] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/24/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Neurofibromatosis type 2 (NF2) is rare genetic disorder mainly characterized by the development of central nervous system lesions, but peripheral nerve pathology may also cause high morbidity including pain, motor, and sensory loss. OBJECTIVE To describe the tumor burden of patients with peripheral nerve pathology in NF2 including peripheral neuropathies and schwannomas and the results of surgery in the latter group. METHODS We conducted a retrospective chart review of all patients with NF2 followed up at our NF2 Reference Center to include all patients suffering from peripheral nerve pathology. Tumor detection relied on focal MRIs based on symptoms. RESULTS Thirty-four patients harboring 105 peripheral nerve schwannomas and 1 perineurioma were included. Schwannomas were mainly located in major nerves (n = 74, 71%) compared with subcutaneous (n = 23, 22%) and intramuscular (n = 8, 7%) cases. Most schwannomas (81/90-90%) were classical discrete tumors while multinodular cases represented only 9 cases (10%). During follow-up, 63 (60%) tumors were operated in 24 patients, including 39 schwannomas of major nerves. A complete resection was achieved in most of the cases (52/63, 83%) with a complete relief of preoperative pain in most patients (57/60, 95%). Persistent motor deficits (5/39, 13%) were mostly encountered in patients operated from multinodular schwannomas (4/5, 80%). Six patients had an associated peripheral neuropathy with 5 cases of pseudo-Charcot-Marie-Tooth-associated amyotrophy. CONCLUSION Surgery remains a safe and effective method of treating peripheral nerve schwannoma-associated pain in NF2, with the exception of rare multinodular tumors. Special attention should be drawn to patients harboring severely debilitating neuropathies and perineuriomas.
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Affiliation(s)
- Matthieu Peyre
- Sorbonne Universités - Department of Neurosurgery, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France.,Genetics and Development of Brain Tumors - CRICM INSERM U1127 CNRS UMR 7225 - Paris Brain Institute, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Suzanne Tran
- Genetics and Development of Brain Tumors - CRICM INSERM U1127 CNRS UMR 7225 - Paris Brain Institute, Hôpital de la Pitié-Salpêtrière, Paris, France.,Sorbonne Universités - Department of Neuropathology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France
| | - Béatrice Parfait
- Université de Paris - Department of Genomic Medecine, Groupe Hospitalier Cochin, APHP, Paris, France.,Genomics and Epigenetics of Rare Tumors - Institut Cochin - (U1016 Inserm/UMR8104 CNRS/UMR-S8104) Department "Development, Reproduction and Cancer", Paris, France
| | - Isabelle Bernat
- Sorbonne Universités - Department of Electrophysiology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France
| | - Franck Bielle
- Genetics and Development of Brain Tumors - CRICM INSERM U1127 CNRS UMR 7225 - Paris Brain Institute, Hôpital de la Pitié-Salpêtrière, Paris, France.,Sorbonne Universités - Department of Neuropathology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France
| | - Michel Kalamarides
- Sorbonne Universités - Department of Neurosurgery, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France.,Genetics and Development of Brain Tumors - CRICM INSERM U1127 CNRS UMR 7225 - Paris Brain Institute, Hôpital de la Pitié-Salpêtrière, Paris, France
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Schulz A, McLean ACL, Rosahl SK. Peripheral nerve vulnerability as risk factor for multiple sclerosis: Possible insights from Neurofibromatosis type 2 (NF2). Mult Scler Relat Disord 2022; 67:104189. [PMID: 36166931 DOI: 10.1016/j.msard.2022.104189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/31/2022] [Accepted: 09/19/2022] [Indexed: 11/26/2022]
Abstract
Despite enormous research efforts, the disease mechanisms causing multiple sclerosis (MS) are still incompletely understood, suggesting a complex and multifaceted pathogenesis. Here, we report the clinical observation that in a designated German center for Neurofibromatosis type 2 (NF2), the number of MS cases among NF2 patients is higher than in the general population. Epidemiological studies investigating a connection between NF2 and MS are difficult to perform due to the rarity of NF2 disease. However, based on the current pathophysiological concepts, we hypothesize that genetically determined vulnerability of peripheral nerves and repeated nerve repair processes might constitute an unrecognized factor to the pathogenesis of MS and might explain the apparent over-representation of MS cases among NF2 patients.
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Affiliation(s)
- Alexander Schulz
- Institute of Human Genetics, University Hospital Jena, Jena 07747, Germany; Clinician Scientist Program OrganAge, Jena University Hospital, Jena 07747, Germany.
| | | | - Steffen K Rosahl
- Neurofibromatosis Center, Department of Neurosurgery, Helios Hospital Erfurt, Erfurt 99089, Germany
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3
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Spatial Distribution and Long-Term Alterations of Peripheral Nerve Lesions in Schwannomatosis. Diagnostics (Basel) 2022; 12:diagnostics12040780. [PMID: 35453828 PMCID: PMC9029522 DOI: 10.3390/diagnostics12040780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To examine the spatial distribution and long-term alterations of peripheral nerve lesions in patients with schwannomatosis by in vivo high-resolution magnetic resonance neurography (MRN). Methods In this prospective study, the lumbosacral plexus as well as the right sciatic, tibial, and peroneal nerves were examined in 15 patients diagnosed with schwannomatosis by a standardized MRN protocol at 3 Tesla. Micro-, intermediate- and macrolesions were assessed according to their number, diameter and spatial distribution. Moreover, in nine patients, peripheral nerve lesions were compared to follow-up examinations after 39 to 71 months. Results In comparison to intermediate and macrolesions, microlesions were the predominant lesion entity at the level of the proximal (p < 0.001), mid- (p < 0.001), and distal thigh (p < 0.01). Compared to the proximal calf level, the lesion number was increased at the proximal (p < 0.05), mid- (p < 0.01), and distal thigh level (p < 0.01), while between the different thigh levels, no differences in lesion numbers were found. In the follow-up examinations, the lesion number was unchanged for micro-, intermediate and macrolesions. The diameter of lesions in the follow-up examination was decreased for microlesions (p < 0.01), not different for intermediate lesions, and increased for macrolesions (p < 0.01). Conclusion Microlesions represent the predominant type of peripheral nerve lesion in schwannomatosis and show a rather consistent distribution pattern in long-term follow-up. In contrast to the accumulation of nerve lesions, primarily in the distal nerve segments in NF2, the lesion numbers in schwannomatosis peak at the mid-thigh level. Towards more distal portions, the lesion number markedly decreases, which is considered as a general feature of other types of small fiber neuropathy.
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4
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Godel T, Bäumer P, Farschtschi S, Püschel K, Hofstadler B, Heiland S, Gelderblom M, Bendszus M, Hagel C, Mautner VF. Long-term Follow-up and Histological Correlation of Peripheral Nervous System Alterations in Neurofibromatosis Type 2. Clin Neuroradiol 2021; 32:277-285. [PMID: 34652463 PMCID: PMC8894150 DOI: 10.1007/s00062-021-01102-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/07/2021] [Indexed: 12/22/2022]
Abstract
Purpose To examine long-term alterations of the dorsal root ganglia (DRG) and the peripheral nerve in patients with neurofibromatosis type 2 (NF2) by in vivo high-resolution magnetic resonance neurography (MRN) and their correlation to histology. Methods In this prospective study the lumbosacral DRG, the right sciatic, tibial, and peroneal nerves were examined in 6 patients diagnosed with NF2 and associated polyneuropathy (PNP) by a standardized MRN protocol at 3 T. Volumes of DRG L3–S2 as well as peripheral nerve lesions were assessed and compared to follow-up examinations after 14–100 months. In one patient, imaging findings were further correlated to histology. Results Follow-up MRN examination showed a non-significant increase of volume for the DRG L3: +0.41% (p = 0.10), L4: +22.41% (p = 0.23), L5: +3.38% (p = 0.09), S1: +10.63% (p = 0.05) and S2: +1.17% (p = 0.57). Likewise, peripheral nerve lesions were not significantly increased regarding size (2.18 mm2 vs. 2.15 mm2, p = 0.89) and number (9.00 vs. 9.33, p = 0.36). Histological analyses identified schwannomas as the major correlate of both DRG hyperplasia and peripheral nerve lesions. For peripheral nerve microlesions additionally clusters of onion-bulb formations were identified. Conclusion Peripheral nervous system alterations seem to be constant or show only a minor increase in adult NF2. Thus, symptoms of PNP may not primarily attributed to the initial schwannoma growth but to secondary long-term processes, with symptoms only occurring if a certain threshold is exceeded. Histology identified grouped areas of Schwann cell proliferations as the correlate of DRG hyperplasia, while for peripheral nerve lesions different patterns could be found.
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Affiliation(s)
- Tim Godel
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Philipp Bäumer
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Center for Radiology dia.log, Vinzenz-von-Paul Str. 8, 84503, Altötting, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Barbara Hofstadler
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Mathias Gelderblom
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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5
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Farschtschi S, Mautner VF, McLean ACL, Schulz A, Friedrich RE, Rosahl SK. The Neurofibromatoses. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:354-360. [PMID: 32657748 DOI: 10.3238/arztebl.2020.0354] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 04/18/2019] [Accepted: 03/20/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Neurofibromatosis of types 1 and 2 (NF1, NF2) and schwannomatosis are the diseases that make up the neurofibromatosis spectrum. With respective incidences of 1 in 3000, 1 in 33 000, and 1 in 60 000 births, they form part of the group of rare tumor-suppressor syndromes. They give rise to a greater tumor burden for the nervous system than any other type of neoplastic disease. New approaches to symptomatic treatment are emerging. METHODS This review is based on articles retrieved by a selective literature search on the pathogenesis, diagnosis, and treatment of the neurofibromatoses. RESULTS NF1 and NF2 are monogenic diseases, while the genetics of schwannomatosis is complex. The three entities are clinically and pathophysiologically distinct. An important aspect of their tumor biology is the alternation of growth phases and growth pauses. Correlations between genotypes and phenotypes are variable, while new mutations and genetic mosaics are common. Ninety-nine percent of patients with NF1 have six or more café-au-lait spots by the age of 12 months; 90-95% of patients with NF2 develop bilateral vestibular schwannomas. In schwannomatosis, pain is the most prominent symptom; two-thirds of those affected develop spinal schwannomas. The severity and prognosis of these disorders are not closely correlated with the radiological findings; rather, neurologic deficits, malignant transformation, and psychosocial stress are of greater clinical importance. Advances in knowledge of pathophysiology have led to the development of targeted treatment approaches. Examples include the off-label treatment of vestibular schwannomas with bevacizumab and of plexiform neurofibromas with MEK inhibitors. CONCLUSION Patients with neurofibromatoses need individualized care. They should be treated in centers of expertise where interdisciplinary consultation is available and new types of pharmacotherapy can be provided.
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Affiliation(s)
- Said Farschtschi
- International Center for Neurofibromatoses (ICNF), Department of Neurology, University MedicalCenter Hamburg-Eppendorf
| | - Victor-Felix Mautner
- International Center for Neurofibromatoses (ICNF), Department of Neurology, University MedicalCenter Hamburg-Eppendorf
| | | | | | - Reinhard E Friedrich
- Department of Oromaxillofacial Surgery, University Medical Center Hamburg-Eppendorf
| | - Steffen K Rosahl
- Neurofibromatosis Center, Department of Neurosurgery, Helios Hospital Erfurt
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Helbing DL, Schulz A, Morrison H. Pathomechanisms in schwannoma development and progression. Oncogene 2020; 39:5421-5429. [PMID: 32616891 PMCID: PMC7410823 DOI: 10.1038/s41388-020-1374-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 12/18/2022]
Abstract
Schwannomas are tumors of the peripheral nervous system, consisting of different cell types. These include tumorigenic Schwann cells, axons, macrophages, T cells, fibroblasts, blood vessels, and an extracellular matrix. All cell types involved constitute an intricate “tumor microenvironment” and play relevant roles in the development and progression of schwannomas. Although Nf2 tumor suppressor gene-deficient Schwann cells are the primary tumorigenic element and principle focus of current research efforts, evidence is accumulating regarding the contributory roles of other cell types in schwannoma pathology. In this review, we aim to provide an overview of intra- and intercellular mechanisms contributing to schwannoma formation. “Genes load the gun, environment pulls the trigger.” -George A. Bray
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Affiliation(s)
- Dario-Lucas Helbing
- Leibniz Institute on Aging, Fritz Lipmann Institute, 07745, Jena, Germany.,Institute of Molecular Cell Biology, Jena University Hospital, Friedrich Schiller University Jena, 07745, Jena, Germany
| | - Alexander Schulz
- Leibniz Institute on Aging, Fritz Lipmann Institute, 07745, Jena, Germany.,MVZ Human Genetics, 99084, Erfurt, Germany
| | - Helen Morrison
- Leibniz Institute on Aging, Fritz Lipmann Institute, 07745, Jena, Germany.
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7
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Farschtschi SC, Mainka T, Glatzel M, Hannekum AL, Hauck M, Gelderblom M, Hagel C, Friedrich RE, Schuhmann MU, Schulz A, Morrison H, Kehrer-Sawatzki H, Luhmann J, Gerloff C, Bendszus M, Bäumer P, Mautner VF. C-Fiber Loss as a Possible Cause of Neuropathic Pain in Schwannomatosis. Int J Mol Sci 2020; 21:ijms21103569. [PMID: 32443592 PMCID: PMC7278954 DOI: 10.3390/ijms21103569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/09/2020] [Accepted: 05/15/2020] [Indexed: 01/22/2023] Open
Abstract
Schwannomatosis is the third form of neurofibromatosis and characterized by the occurrence of multiple schwannomas. The most prominent symptom is chronic pain. We aimed to test whether pain in schwannomatosis might be caused by small-fiber neuropathy. Twenty patients with schwannomatosis underwent neurological examination and nerve conduction studies. Levels of pain perception as well as anxiety and depression were assessed by established questionnaires. Quantitative sensory testing (QST) and laser-evoked potentials (LEP) were performed on patients and controls. Whole-body magnetic resonance imaging (wbMRI) and magnetic resonance neurography (MRN) were performed to quantify tumors and fascicular nerve lesions; skin biopsies were performed to determine intra-epidermal nerve fiber density (IENFD). All patients suffered from chronic pain without further neurological deficits. The questionnaires indicated neuropathic symptoms with significant impact on quality of life. Peripheral nerve tumors were detected in all patients by wbMRI. MRN showed additional multiple fascicular nerve lesions in 16/18 patients. LEP showed significant faster latencies compared to normal controls. Finally, IENFD was significantly reduced in 13/14 patients. Our study therefore indicates the presence of small-fiber neuropathy, predominantly of unmyelinated C-fibers. Fascicular nerve lesions are characteristic disease features that are associated with faster LEP latencies and decreased IENFD. Together these methods may facilitate differential diagnosis of schwannomatosis.
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Affiliation(s)
- Said C. Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
- Correspondence: ; Tel.: +49(0)407410-53869
| | - Tina Mainka
- Department of Neurology, Charité University Medicine, 10117 Berlin, Germany;
- Berlin Institute of Health, 10178 Berlin, Germany
| | - Markus Glatzel
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.G.); (C.H.)
| | - Anna-Lena Hannekum
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
| | - Michael Hauck
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
- Department of Neurophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Mathias Gelderblom
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
| | - Christian Hagel
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.G.); (C.H.)
| | - Reinhard E. Friedrich
- Department of Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Martin U. Schuhmann
- Department of Neurosurgery, University Medical Center Tübingen, 72076 Tübingen, Germany;
| | - Alexander Schulz
- Leibniz Institute on Aging, Fritz Lipmann Institute, 07745 Jena, Germany; (A.S.); (H.M.)
- MVZ Human Genetics, 99084 Erfurt, Germany
| | - Helen Morrison
- Leibniz Institute on Aging, Fritz Lipmann Institute, 07745 Jena, Germany; (A.S.); (H.M.)
| | | | - Jan Luhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
| | - Martin Bendszus
- Department of Neuroradiology, University Medical Center Heidelberg, 69120 Heidelberg, Germany; (M.B.); (P.B.)
| | - Philipp Bäumer
- Department of Neuroradiology, University Medical Center Heidelberg, 69120 Heidelberg, Germany; (M.B.); (P.B.)
- Department of Radiology, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
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Winter N, Dohrn MF, Wittlinger J, Loizides A, Gruber H, Grimm A. Role of high-resolution ultrasound in detection and monitoring of peripheral nerve tumor burden in neurofibromatosis in children. Childs Nerv Syst 2020; 36:2427-2432. [PMID: 32561982 PMCID: PMC7575466 DOI: 10.1007/s00381-020-04718-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE Peripheral nerve sheath tumors are hallmark findings in neurofibromatosis types 1 and 2. With increasing size, they typically lead to neurological symptoms, and NF1 patients have a lifetime risk of 8-13% for developing malignant peripheral nerve sheath tumors. Medical imaging is therefore highly needed for early detection and exact localization of symptomatic or potentially malignant tumors. This review will give an overview of the ultrasound characteristics of peripheral nerve sheath tumors and findings in patients with neurofibromatosis types 1 and 2. METHODS A systematic search of electronic databases, reference lists, and unpublished literature was conducted including the keywords "schwannoma," "neurofibroma," "neurofibromatosis," "benign and malignant peripheral nerve sheath tumor." RESULTS The high-resolution allows a clear analysis of tumor echotexture, definition of margins, and the relation to the parent nerve. The use of color duplex/Doppler and contrast agent adds valuable information for the differentiation of benign and malignant tumors. CONCLUSION High-resolution ultrasound is a well-established, non-invasive, and easily repeatable first-line tool in diagnostic procedures of soft tissue tumors.
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Affiliation(s)
- Natalie Winter
- Department of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Maike F. Dohrn
- University Hospital of the RWTH Aachen University, Aachen, Germany
| | - Julia Wittlinger
- Department of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | | | - Hannes Gruber
- Department of Radiology, University of Innsbruck, Innsbruck, Austria
| | - Alexander Grimm
- Department of Neurology and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
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Kalamarides M, Bernat I, Peyre M. Extracapsular dissection in peripheral nerve schwannoma surgery using bright light and fluorescein sodium visualization: case series. Acta Neurochir (Wien) 2019; 161:2447-2452. [PMID: 31679103 DOI: 10.1007/s00701-019-04071-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/11/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Schwannomas are the most frequent peripheral nerve sheath tumors and are treated by surgical resection when symptomatic. Tumor removal is performed by intraneural dissection and enucleation. In order to safely remove the tumor from the nerve, the use of sodium fluorescein has recently been proposed to distinguish the tumor from the adjacent normal nerve fibers, before incision of the tumor pseudocapsule and during intraneural tumor dissection. METHODS We report a consecutive case series of 5 peripheral nerve schwannomas operated in 4 patients, in which we evaluate the usefulness of sodium fluorescein compared to usual visual landmarks, at each step of the surgical procedure. RESULTS After exposition of the schwannoma, sodium fluorescein helped with the localization of intracapsular en passant nerve fascicles in only one case. Hence, the definition of a safe entry zone for capsular incision relied mainly on nerve monitoring and direct visualization of en passant nerve fascicles under microscope. During intraneural dissection, there was a sharp contrast between the fluorescent tumor and the non-fluorescent adjacent pseudocapsule in most cases but the colorimetric variation between tumor and normal tissue induced by fluorescence did not outperform the natural contrast between the yellow true capsule and the gray-red layers of the pseudocapsule. CONCLUSION Based on these results, we consider that the limited additional value of sodium fluorescein in primary peripheral nerve schwannoma surgery does not warrant its use in daily clinical practice. Additional studies are needed to assess its usefulness during the surgery of recurrences and tumors which are intertwined with several fascicles of origin such as neurofibromas.
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10
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MR Neurography: Normative Values in Correlation to Demographic Determinants in Children and Adolescents. Clin Neuroradiol 2019; 30:671-677. [DOI: 10.1007/s00062-019-00834-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 08/19/2019] [Indexed: 01/30/2023]
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11
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Godel T, Bäumer P, Farschtschi S, Gugel I, Kronlage M, Hofstadler B, Heiland S, Gelderblom M, Bendszus M, Mautner VF. Peripheral nervous system alterations in infant and adult neurofibromatosis type 2. Neurology 2019; 93:e590-e598. [PMID: 31300546 DOI: 10.1212/wnl.0000000000007898] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/18/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To examine the involvement of dorsal root ganglia and peripheral nerves in children with neurofibromatosis type 2 compared to healthy controls and symptomatic adults by in vivo high-resolution magnetic resonance neurography. METHODS In this prospective multicenter study, the lumbosacral dorsal root ganglia and sciatic, tibial, and peroneal nerves were examined in 9 polyneuropathy-negative children diagnosed with neurofibromatosis type 2 by a standardized magnetic resonance neurography protocol at 3T. Volumes of dorsal root ganglia L3 to S2 and peripheral nerve lesions were assessed and compared to those of 29 healthy children. Moreover, dorsal root ganglia volumes and peripheral nerve lesions were compared to those of 14 adults with neurofibromatosis type 2. RESULTS Compared to healthy controls, dorsal root ganglia hypertrophy was a consistent finding in children with neurofibromatosis type 2 (L3 +255%, L4 +289%, L5 +250%, S1 +257%, and S2 +218%, p < 0.001) with an excellent diagnostic accuracy. Moreover, peripheral nerve lesions occurred with a high frequency in those children compared to healthy controls (18.89 ± 11.11 vs 0.90 ± 1.08, p < 0.001). Children and adults with neurofibromatosis type 2 showed nonsignificant differences in relative dorsal root ganglia hypertrophy rates (p = 0.85) and peripheral nerve lesions (p = 0.28). CONCLUSIONS Alterations of peripheral nerve segments occur early in the course of neurofibromatosis type 2 and are evident even in children not clinically affected by peripheral polyneuropathy. While those early alterations show similar characteristics compared to adults with neurofibromatosis type 2, the findings of this study suggest that secondary processes might be responsible for the development and severity of associated polyneuropathy.
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Affiliation(s)
- Tim Godel
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany.
| | - Philipp Bäumer
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
| | - Said Farschtschi
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
| | - Isabel Gugel
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
| | - Moritz Kronlage
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
| | - Barbara Hofstadler
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
| | - Sabine Heiland
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
| | - Mathias Gelderblom
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
| | - Martin Bendszus
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
| | - Victor-Felix Mautner
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
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12
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Kehrer‐Sawatzki H, Kordes U, Seiffert S, Summerer A, Hagel C, Schüller U, Farschtschi S, Schneppenheim R, Bendszus M, Godel T, Mautner V. Co-occurrence of schwannomatosis and rhabdoid tumor predisposition syndrome 1. Mol Genet Genomic Med 2018; 6:627-637. [PMID: 29779243 PMCID: PMC6081224 DOI: 10.1002/mgg3.412] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 03/31/2018] [Accepted: 04/18/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The clinical phenotype associated with germline SMARCB1 mutations has as yet not been fully documented. It is known that germline SMARCB1 mutations may cause rhabdoid tumor predisposition syndrome (RTPS1) or schwannomatosis. However, the co-occurrence of rhabdoid tumor and schwannomas in the same patient has not so far been reported. METHODS We investigated a family with members harboring a germline SMARCB1 deletion by means of whole-body MRI as well as high-resolution microstructural magnetic resonance neurography (MRN). Breakpoint-spanning PCRs were performed to characterize the SMARCB1 deletion and its segregation in the family. RESULTS The index patient of this family was in complete continuous remission for an atypical teratoid/rhabdoid tumor (AT/RT) treated at the age of 2 years. However, at the age of 21 years, she exhibited paraparesis of her legs and MRI investigations revealed multiple intrathoracic and spinal schwannomas. Breakpoint-spanning PCRs indicated that the germline deletion segregating in the family encompasses 6.4-kb and includes parts of SMARCB1 intron 7, exons 8-9 and 3.3-kb located telomeric to exon 9 including the SMARCB1 3' UTR. The analysis of sequences at the deletion breakpoints showed that the deletion has been caused by replication errors including template-switching. The patient had inherited the deletion from her 56-year-old healthy mother who did not exhibit schwannomas or other tumors as determined by whole-body MRI. However, MRN of the peripheral nerves of the mother's extremities revealed multiple fascicular microlesions which have been previously identified as indicative of schwannomatosis-associated subclinical peripheral nerve pathology. CONCLUSION The occurrence of schwannomatosis-associated clinical symptoms independent of the AT/RT as the primary disease should be considered in long-term survivors of AT/RT. Furthermore, our investigations indicate that germline SMARCB1 mutation carriers not presenting RTs or schwannomatosis-associated clinical symptoms may nevertheless exhibit peripheral nerve pathology as revealed by MRN.
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Affiliation(s)
| | - Uwe Kordes
- Department of Pediatric Hematology and OncologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | | | - Anna Summerer
- Institute of Human GeneticsUniversity of UlmUlmGermany
| | - Christian Hagel
- Institute of NeuropathologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Ulrich Schüller
- Department of Pediatric Hematology and OncologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Institute of NeuropathologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Research Institute Children's Cancer Center HamburgHamburgGermany
| | - Said Farschtschi
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Reinhard Schneppenheim
- Department of Pediatric Hematology and OncologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Martin Bendszus
- Department of NeuroradiologyUniversity of Heidelberg Medical CenterHeidelbergGermany
| | - Tim Godel
- Department of NeuroradiologyUniversity of Heidelberg Medical CenterHeidelbergGermany
| | - Victor‐Felix Mautner
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
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13
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Godel T, Mautner VF, Farschtschi S, Pham M, Schwarz D, Kronlage M, Gugel I, Heiland S, Bendszus M, Bäumer P. Dorsal root ganglia volume differentiates schwannomatosis and neurofibromatosis 2. Ann Neurol 2018; 83:854-857. [PMID: 29469988 DOI: 10.1002/ana.25191] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/20/2018] [Accepted: 02/21/2018] [Indexed: 12/13/2022]
Abstract
Schwannomatosis and neurofibromatosis type 2 are hereditary tumor syndromes, and peripheral neuropathy has been reported in both. We prospectively applied in vivo morphometric measurement of dorsal root ganglia volume in 16 schwannomatosis patients, 14 neurofibromatosis type 2 patients, and 26 healthy controls by magnetic resonance neurography. Compared to healthy controls, dorsal root ganglia hypertrophy was a consistent finding in neurofibromatosis type 2 (L3, + 267%; L4, + 235%; L5, + 241%; S1, + 300%; S2, + 242%; Bonferroni-adjusted p < 0.001) but not in schwannomatosis. Dorsal root ganglia may be a vulnerable site in origination of areflexia and sensory loss and a useful diagnostic marker in neurofibromatosis type 2. Ann Neurol 2018;83:854-857.
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Affiliation(s)
- Tim Godel
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg
| | | | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Mirko Pham
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg.,Department of Neuroradiology, Würzburg University Hospital, Würzburg
| | - Daniel Schwarz
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg
| | - Moritz Kronlage
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg
| | - Isabel Gugel
- Department of Neurosurgery, Tübingen University Hospital, Tübingen
| | - Sabine Heiland
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg
| | - Martin Bendszus
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg
| | - Philipp Bäumer
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg.,Department of Radiology, German Cancer Research Institute, Heidelberg, Germany
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14
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Nf2 Mutation in Schwann Cells Delays Functional Neural Recovery Following Injury. Neuroscience 2018; 374:205-213. [PMID: 29408605 DOI: 10.1016/j.neuroscience.2018.01.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/23/2018] [Accepted: 01/26/2018] [Indexed: 11/21/2022]
Abstract
Merlin is the protein product of the NF2 tumor suppressor gene. Germline NF2 mutation leads to neurofibromatosis type 2 (NF2), characterized by multiple intracranial and spinal schwannomas. Patients with NF2 also frequently develop peripheral neuropathies. While the role of merlin in SC neoplasia is well established, its role in SC homeostasis is less defined. Here we explore the role of merlin in SC responses to nerve injury and their ability to support axon regeneration. We performed sciatic nerve crush in wild-type (WT) and in P0SchΔ39-121 transgenic mice that express a dominant negative Nf2 isoform in SCs. Recovery of nerve function was assessed by measuring mean contact paw area on a pressure pad 7, 21, 60, and 90 days following nerve injury and by nerve conduction assays at 90 days following injury. After 90 days, the nerves were harvested and axon regeneration was quantified stereologically. Myelin ultrastructure was analyzed by electron microscopy. Functional studies showed delayed nerve regeneration in Nf2 mutant mice compared to the WT mice. Delayed neural recovery correlated with a reduced density of regenerated axons and increased endoneurial space in mutants compared to WT mice. Nevertheless, functional and nerve conduction measures ultimately recovered to similar levels in WT and Nf2 mutant mice, while there was a small (∼17%) reduction in the percent of regenerated axons in the Nf2 mutant mice. The data suggest that merlin function in SCs regulates neural ultrastructure and facilitates neural regeneration, in addition to its role in SC neoplasia.
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15
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Kronlage M, Schwehr V, Schwarz D, Godel T, Heiland S, Bendszus M, Bäumer P. Magnetic Resonance Neurography. Clin Neuroradiol 2017; 29:19-26. [DOI: 10.1007/s00062-017-0633-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/21/2017] [Indexed: 12/29/2022]
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16
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Telleman JA, Stellingwerff MD, Brekelmans GJ, Visser LH. Nerve ultrasound shows subclinical peripheral nerve involvement in neurofibromatosis type 2. Muscle Nerve 2017; 57:312-316. [DOI: 10.1002/mus.25734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Johan A. Telleman
- Department of Neurology and Clinical Neurophysiology; Elisabeth-Tweesteden Hospital; Hilvarenbeekseweg 60, 5022 GC Tilburg The Netherlands
| | - Menno D. Stellingwerff
- Department of Neurology and Clinical Neurophysiology; Elisabeth-Tweesteden Hospital; Hilvarenbeekseweg 60, 5022 GC Tilburg The Netherlands
| | - Geert J. Brekelmans
- Department of Neurology and Clinical Neurophysiology; Elisabeth-Tweesteden Hospital; Hilvarenbeekseweg 60, 5022 GC Tilburg The Netherlands
| | - Leo H. Visser
- Department of Neurology and Clinical Neurophysiology; Elisabeth-Tweesteden Hospital; Hilvarenbeekseweg 60, 5022 GC Tilburg The Netherlands
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17
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Neuropathies in the setting of Neurofibromatosis tumor syndromes: Complexities and opportunities. Exp Neurol 2017; 299:334-344. [PMID: 28587874 DOI: 10.1016/j.expneurol.2017.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/03/2017] [Accepted: 06/02/2017] [Indexed: 12/11/2022]
Abstract
The term 'Neurofibromatosis' (NF) comprises a group of rare diseases with related clinical presentations but distinct genetic conditions. All currently known types - NF1, NF2 and Schwannomatosis - predispose afflicted individuals to the development of glial cell-derived (gliogenic) tumors. Furthermore, the occurrence of neuropathic symptoms, which add to the overall neurologic disability of patients, has been described in all disease entities. We show that neuropathic symptoms are a common and clinically important, yet infrequently studied feature in the NF spectrum. However, the clinical relevance and respective underlying pathogenesis, varies greatly among the different NF types. In this review, we summarize and interpret the latest basic research findings, as well as clinical observations, in respect of Neurofibromatosis-associated neuropathies.
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18
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Winter N, Rattay TW, Axer H, Schäffer E, Décard BF, Gugel I, Schuhmann M, Grimm A. Ultrasound assessment of peripheral nerve pathology in neurofibromatosis type 1 and 2. Clin Neurophysiol 2017; 128:702-706. [PMID: 28315612 DOI: 10.1016/j.clinph.2017.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The neurofibromatoses (NF) type 1 and 2 are hereditary tumor predisposition syndromes caused by germline mutations in the NF1 and NF2 tumor suppressor genes. In NF1 and 2, peripheral nerve tumors occur regularly. For further characterizing nerve ultrasound was performed in patients with NF1 and 2. METHODS Patients with established diagnosis of NF1 (n=27) and NF2 (n=10) were included. Ultrasound of peripheral nerves and cervical roots was performed during routine follow-up visits. Healthy volunteers were studied for comparison. RESULTS In patients with NF1, median cross-sectional area (CSA) of most nerves was significantly increased compared to controls and to NF2 due to generalized plexiform tumors, which arose out of multiple fascicles in 23 of 27 patients (85%). These were often accompanied by cutaneous or subcutaneous neurofibromas. In NF2, the overall aspect of peripheral nerves consisted of localized schwannomas (80%) and, apart from that, normal nerve segments. CONCLUSION Nerve ultrasound is able to visualize different nerve pathologies in NF1 and NF2. It is a precise and inexpensive screening method for peripheral nerve manifestation in neurofibromatosis and should be considered as the first choice screening imaging modality for all peripheral nerves within reach of non-invasive ultrasound techniques. SIGNIFICANCE Ultrasound patterns of peripheral nerve pathologies are described for the first time in a large cohort of patients with NF1 and NF2. It is a suitable screening tool and enables targeted MRI analysis.
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Affiliation(s)
- Natalie Winter
- Center of Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard-Karl University Tübingen, Tübingen, Germany
| | - Tim W Rattay
- Center of Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard-Karl University Tübingen, Tübingen, Germany; German Research Center for Neurodegenerative Diseases, (DZNE), Tübingen, Germany
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Friedrich-Schiller University Jena, Germany
| | - Eva Schäffer
- Department of Neurology, Kiel University Hospital, Albrecht-University Kiel, Germany
| | - Bernhard F Décard
- Department of Neurology, Basel University Hospital, University Basel, Switzerland
| | - Isabel Gugel
- Department of Neurosurgery, Tübingen University Hospital, Eberhard-Karl University Tübingen, Germany; Center of Neurofibromatosis, Center of Rare Diseases Tübingen, Tübingen University Hospital, Eberhard-Karl University Tübingen, Germany
| | - Martin Schuhmann
- Department of Neurosurgery, Tübingen University Hospital, Eberhard-Karl University Tübingen, Germany; Center of Neurofibromatosis, Center of Rare Diseases Tübingen, Tübingen University Hospital, Eberhard-Karl University Tübingen, Germany
| | - Alexander Grimm
- Center of Neurology, Tübingen University Hospital and Hertie Institute for Clinical Brain Research, Eberhard-Karl University Tübingen, Tübingen, Germany.
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19
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20
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Farschtschi S, Gelderblom M, Buschbaum S, Bostock H, Grafe P, Mautner VF. Muscle action potential scans and ultrasound imaging in neurofibromatosis type 2. Muscle Nerve 2016; 55:350-358. [PMID: 27422240 DOI: 10.1002/mus.25256] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The neuropathy in patients with neurofibromatosis type 2 (NF2) is difficult to quantify and follow up. In this study we compared 3 methods that may help assess motor axon pathology in NF2 patients. METHODS Nerve conduction studies in median nerves were supplemented by deriving motor unit number estimates (MUNEs) from compound muscle action potential (CMAP) scans and by high-resolution ultrasound (US) peripheral nerve imaging. RESULTS CMAP amplitudes and nerve conduction velocity were normal in the vast majority of affected individuals, but CMAP scan MUNE revealed denervation and reinnervation in many peripheral nerves. In addition, nerve US imaging enabled monitoring of the size and number of schwannoma-like fascicular enlargements in median nerve trunks. CONCLUSION In contrast to conventional nerve conduction studies, CMAP scan MUNE in combination with US nerve imaging can quantify the NF2-associated neuropathy and may help to monitor disease progression and drug treatments. Muscle Nerve 55: 350-358, 2017.
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Affiliation(s)
- Said Farschtschi
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
| | - Mathias Gelderblom
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
| | - Sabriena Buschbaum
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
| | - Hugh Bostock
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - Peter Grafe
- Physiological Genomics, Institute of Physiology, Ludwig-Maximilians University Munich, Pettenkoferstrasse 12, 80336, Munich, Germany
| | - Victor F Mautner
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
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21
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Bäumer P, Kele H, Xia A, Weiler M, Schwarz D, Bendszus M, Pham M. Posterior interosseous neuropathy: Supinator syndrome vs fascicular radial neuropathy. Neurology 2016; 87:1884-1891. [PMID: 27683851 PMCID: PMC5100717 DOI: 10.1212/wnl.0000000000003287] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/12/2016] [Indexed: 12/19/2022] Open
Abstract
Objective: To investigate the spatial pattern of lesion dispersion in posterior interosseous neuropathy syndrome (PINS) by high-resolution magnetic resonance neurography. Methods: This prospective study was approved by the local ethics committee and written informed consent was obtained from all patients. In 19 patients with PINS and 20 healthy controls, a standardized magnetic resonance neurography protocol at 3-tesla was performed with coverage of the upper arm and elbow (T2-weighted fat-saturated: echo time/repetition time 52/7,020 milliseconds, in-plane resolution 0.27 × 0.27 mm2). Lesion classification of the radial nerve trunk and its deep branch (which becomes the posterior interosseous nerve) was performed by visual rating and additional quantitative analysis of normalized T2 signal of radial nerve voxels. Results: Of 19 patients with PINS, only 3 (16%) had a focal neuropathy at the entry of the radial nerve deep branch into the supinator muscle at elbow/forearm level. The other 16 (84%) had proximal radial nerve lesions at the upper arm level with a predominant lesion focus 8.3 ± 4.6 cm proximal to the humeroradial joint. Most of these lesions (75%) followed a specific somatotopic pattern, involving only those fascicles that would form the posterior interosseous nerve more distally. Conclusions: PINS is not necessarily caused by focal compression at the supinator muscle but is instead frequently a consequence of partial fascicular lesions of the radial nerve trunk at the upper arm level. Neuroimaging should be considered as a complementary diagnostic method in PINS.
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Affiliation(s)
- Philipp Bäumer
- From the Departments of Neuroradiology (P.B., A.X., D.S., M.B., M.P.) and Neurology (M.W.), Heidelberg University Hospital; Department of Radiology (P.B.), German Cancer Research Center, Heidelberg; and Center for Peripheral Neurology (H.K.), Hamburg, Germany; and the Department of Neuroradiology, University Clinic Würzburg.
| | - Henrich Kele
- From the Departments of Neuroradiology (P.B., A.X., D.S., M.B., M.P.) and Neurology (M.W.), Heidelberg University Hospital; Department of Radiology (P.B.), German Cancer Research Center, Heidelberg; and Center for Peripheral Neurology (H.K.), Hamburg, Germany; and the Department of Neuroradiology, University Clinic Würzburg
| | - Annie Xia
- From the Departments of Neuroradiology (P.B., A.X., D.S., M.B., M.P.) and Neurology (M.W.), Heidelberg University Hospital; Department of Radiology (P.B.), German Cancer Research Center, Heidelberg; and Center for Peripheral Neurology (H.K.), Hamburg, Germany; and the Department of Neuroradiology, University Clinic Würzburg
| | - Markus Weiler
- From the Departments of Neuroradiology (P.B., A.X., D.S., M.B., M.P.) and Neurology (M.W.), Heidelberg University Hospital; Department of Radiology (P.B.), German Cancer Research Center, Heidelberg; and Center for Peripheral Neurology (H.K.), Hamburg, Germany; and the Department of Neuroradiology, University Clinic Würzburg
| | - Daniel Schwarz
- From the Departments of Neuroradiology (P.B., A.X., D.S., M.B., M.P.) and Neurology (M.W.), Heidelberg University Hospital; Department of Radiology (P.B.), German Cancer Research Center, Heidelberg; and Center for Peripheral Neurology (H.K.), Hamburg, Germany; and the Department of Neuroradiology, University Clinic Würzburg
| | - Martin Bendszus
- From the Departments of Neuroradiology (P.B., A.X., D.S., M.B., M.P.) and Neurology (M.W.), Heidelberg University Hospital; Department of Radiology (P.B.), German Cancer Research Center, Heidelberg; and Center for Peripheral Neurology (H.K.), Hamburg, Germany; and the Department of Neuroradiology, University Clinic Würzburg
| | - Mirko Pham
- From the Departments of Neuroradiology (P.B., A.X., D.S., M.B., M.P.) and Neurology (M.W.), Heidelberg University Hospital; Department of Radiology (P.B.), German Cancer Research Center, Heidelberg; and Center for Peripheral Neurology (H.K.), Hamburg, Germany; and the Department of Neuroradiology, University Clinic Würzburg
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22
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Farschtschi S, Mautner VF, Pham M, Nguyen R, Kehrer-Sawatzki H, Hutter S, Friedrich RE, Schulz A, Morrison H, Jones DTW, Bendszus M, Bäumer P. Multifocal nerve lesions andLZTR1germline mutations in segmental schwannomatosis. Ann Neurol 2016; 80:625-8. [DOI: 10.1002/ana.24753] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Said Farschtschi
- Department of Neurology; University Medical Center Hamburg-Eppendorf, University of Hamburg; Hamburg Germany
| | - Victor-Felix Mautner
- Department of Neurology; University Medical Center Hamburg-Eppendorf, University of Hamburg; Hamburg Germany
| | - Mirko Pham
- Department of Neuroradiology; Heidelberg University Hospital; Heidelberg Germany
| | - Rosa Nguyen
- Department of Oncology; St Jude Children's Research Hospital; Memphis TN
| | | | - Sonja Hutter
- Division of Pediatric Neuro-oncology; German Cancer Research Center; Heidelberg Germany
| | - Reinhard E. Friedrich
- Department of Maxillofacial Surgery; University Medical Center Hamburg-Eppendorf, University of Hamburg; Hamburg Germany
| | - Alexander Schulz
- Leibniz Institute on Aging; Fritz Lipmann Institute; Jena Germany
| | - Helen Morrison
- Leibniz Institute on Aging; Fritz Lipmann Institute; Jena Germany
| | - David T. W. Jones
- Division of Pediatric Neuro-oncology; German Cancer Research Center; Heidelberg Germany
| | - Martin Bendszus
- Department of Neuroradiology; Heidelberg University Hospital; Heidelberg Germany
| | - Philipp Bäumer
- Department of Neuroradiology; Heidelberg University Hospital; Heidelberg Germany
- Department of Radiology; German Cancer Research Center; Heidelberg Germany
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Plotkin SR, Albers AC, Babovic-Vuksanovic D, Blakeley JO, Breakefield XO, Dunn CM, Evans DG, Fisher MJ, Friedman JM, Giovannini M, Gutmann DH, Kalamarides M, McClatchey AI, Messiaen L, Morrison H, Parkinson DB, Stemmer-Rachamimov AO, Van Raamsdonk CD, Riccardi VM, Rosser T, Schindeler A, Smith MJ, Stevenson DA, Ullrich NJ, van der Vaart T, Weiss B, Widemann BC, Zhu Y, Bakker AC, Lloyd AC. Update from the 2013 International Neurofibromatosis Conference. Am J Med Genet A 2014; 164A:2969-78. [PMID: 25255738 PMCID: PMC4236251 DOI: 10.1002/ajmg.a.36754] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 08/14/2014] [Indexed: 12/16/2022]
Affiliation(s)
- Scott R. Plotkin
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Anne C. Albers
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | | | | | - Xandra O. Breakefield
- Neuroscience Center, Center for Molecular Imaging and Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Courtney M. Dunn
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - D. Gareth Evans
- Center for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre, University of Manchester, UK
| | - Michael J. Fisher
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jan M. Friedman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Marco Giovannini
- Center for Neural Tumor Research, House Research Institute, Los Angeles, CA
| | - David H. Gutmann
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | | | - Andrea I. McClatchey
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Ludwine Messiaen
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL
| | | | - David B. Parkinson
- Centre for Biomedical Research, University of Plymouth, Peninsula College of Medicine and Dentistry, Plymouth, UK
| | | | | | | | - Tena Rosser
- Department of Neurology, Children's Hospital, Los Angeles, University of Southern California
| | - Aaron Schindeler
- Kids' Research Institute, The Children's Hospital at Westmead, University of Sydney, Westmead, Australia
| | - Miriam J. Smith
- Center for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre, University of Manchester, UK
| | - David A. Stevenson
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Nicole J. Ullrich
- Departments of Neurology and Pediatric Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Brian Weiss
- Division of Hematology/Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Yuan Zhu
- Gilbert Neurofibromatosis Institute, Children's National Medical Center, Washington, DC
| | | | - Alison C. Lloyd
- MRC Laboratory for Molecular Cell Biology, University College London, UK
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Diagnostic Signs of Motor Neuropathy in MR Neurography: Nerve Lesions and Muscle Denervation. Eur Radiol 2014; 25:1497-503. [DOI: 10.1007/s00330-014-3498-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/23/2014] [Accepted: 11/11/2014] [Indexed: 12/30/2022]
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25
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Pham M. [MR neurography for lesion localization in the peripheral nervous system. Why, when and how?]. DER NERVENARZT 2014; 85:221-35; quiz 236-7. [PMID: 24519060 DOI: 10.1007/s00115-013-3951-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Peripheral neuropathies are frequent disorders which are often challenging in the diagnostic work-up. Diagnostic difficulties first and foremost arise with regard to lesion localization and the precise definition of spatial lesion patterns. Magnetic resonance (MR) neurography as a diagnostic imaging tool directly visualizes nerve lesions thereby facilitating lesion localization not only in traumatic nerve lesions but also in the large and heterogeneous group of intrinsic, spontaneously occurring non-focal neuropathies. The major diagnostic sign for lesion detection and localization is the T2 lesion which can be evaluated with high spatial resolution at the anatomical level of nerve fascicles. Lesion detection at the fascicular level by MR neurography advances the diagnostic work-up in the peripheral nervous system (PNS), because fascicular and partial nerve lesions of spontaneously occurring intrinsic neuropathies and polyneuropathies present a classical diagnostic pitfall for traditional localization by means of physical findings and electrophysiology. With the appropriate techniques and strategies MR neurography can now cover large anatomical areas of the PNS in a single examination session.
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Affiliation(s)
- M Pham
- Abteilung für Neuroradiologie, Universitätsklinikum Heidelberg, INF 400, 69120, Heidelberg, Deutschland,
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26
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Schulz A, Zoch A, Morrison H. A neuronal function of the tumor suppressor protein merlin. Acta Neuropathol Commun 2014; 2:82. [PMID: 25012216 PMCID: PMC4149232 DOI: 10.1186/s40478-014-0082-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 06/30/2014] [Indexed: 02/07/2023] Open
Abstract
Mutagenic loss of the NF2 tumor suppressor gene encoded protein merlin is known to provoke the hereditary neoplasia syndrome, Neurofibromatosis type 2 (NF2). In addition to glial cell-derived tumors in the PNS and CNS, disease-related lesions also affect the skin and the eyes. Furthermore, 60% of NF2 patients suffer from peripheral nerve damage, clinically referred to as peripheral neuropathy. Strikingly, NF2-associated neuropathy often occurs in the absence of nerve damaging tumors, suggesting tumor-independent events. Recent findings indicate an important role of merlin in neuronal cell types concerning neuromorphogenesis, axon structure maintenance and communication between axons and Schwann cells. In this review, we compile clinical and experimental evidences for the underestimated role of the tumor suppressor merlin in the neuronal compartment.
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27
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Pham M, Bäumer P, Meinck HM, Schiefer J, Weiler M, Bendszus M, Kele H. Anterior interosseous nerve syndrome: fascicular motor lesions of median nerve trunk. Neurology 2014; 82:598-606. [PMID: 24415574 PMCID: PMC3963415 DOI: 10.1212/wnl.0000000000000128] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objective: We sought to determine lesion sites and spatial lesion patterns in spontaneous anterior interosseous nerve syndrome (AINS) with high-resolution magnetic resonance neurography (MRN). Methods: In 20 patients with AINS and 20 age- and sex-matched controls, MRN of median nerve fascicles was performed at 3T with large longitudinal anatomical coverage (upper arm/elbow/forearm): 135 contiguous axial slices (T2-weighted: echo time/repetition time 52/7,020 ms, time of acquisition: 15 minutes 48 seconds, in-plane resolution: 0.25 × 0.25 mm). Lesion classification was performed by visual inspection and by quantitative analysis of normalized T2 signal after segmentation of median nerve voxels. Results: In all patients and no controls, T2 lesions of individual fascicles were observed within upper arm median nerve trunk and strictly followed a somatotopic/internal topography: affected were those motor fascicles that will form the anterior interosseous nerve further distally while other fascicles were spared. Predominant lesion focus was at a mean distance of 14.6 ± 5.4 cm proximal to the humeroradial joint. Discriminative power of quantitative T2 signal analysis and of qualitative lesion rating was high, with 100% sensitivity and 100% specificity (p < 0.0001). Fascicular T2 lesion patterns were rated as multifocal (n = 17), monofocal (n = 2), or indeterminate (n = 1) by 2 independent observers with strong agreement (kappa = 0.83). Conclusion: It has been difficult to prove the existence of fascicular/partial nerve lesions in spontaneous neuropathies using clinical and electrophysiologic findings. With MRN, fascicular lesions with strict somatotopic organization were observed in upper arm median nerve trunks of patients with AINS. Our data strongly support that AINS in the majority of cases is not a surgically treatable entrapment neuropathy but a multifocal mononeuropathy selectively involving, within the main trunk of the median nerve, the motor fascicles that continue distally to form the anterior interosseous nerve.
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Affiliation(s)
- Mirko Pham
- From the Departments of Neuroradiology (M.P., P.B., M.B.) and Neurology (H.-M.M., M.W.), Heidelberg University Hospital; Clinical Cooperation Unit Neurooncology (M.W.), German Cancer Research Center (DKFZ), Heidelberg; Department of Neurology (J.S.), RWTH University Hospital Aachen; and Center for Neurology and Clinical Neurophysiology Neuer Wall (H.K.), Hamburg, Germany
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Yurrebaso I, Casado OL, Barcena J, Perez de Nanclares G, Aguirre U. Clinical, electrophysiological and magnetic resonance findings in a family with hereditary neuropathy with liability to pressure palsies caused by a novel PMP22 mutation. Neuromuscul Disord 2014; 24:56-62. [DOI: 10.1016/j.nmd.2013.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 07/20/2013] [Accepted: 09/05/2013] [Indexed: 12/19/2022]
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Sagnelli A, Piscosquito G, Pareyson D. Inherited neuropathies: an update. J Neurol 2013; 260:2684-90. [PMID: 24061768 DOI: 10.1007/s00415-013-7113-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 09/11/2013] [Accepted: 09/12/2013] [Indexed: 01/21/2023]
Abstract
In this review, progress in hereditary neuropathy research published in the Journal of Neurology over the last 18 months is summarised.
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Affiliation(s)
- Anna Sagnelli
- Clinic of Central and Peripheral Degenerative Neuropathies Unit, Department of Clinical Neurosciences, IRCCS Foundation, "C. Besta" Neurological Institute, via Celoria 11, 20133, Milan, Italy
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MR neurography in ulnar neuropathy as surrogate parameter for the presence of disseminated neuropathy. PLoS One 2012; 7:e49742. [PMID: 23166762 PMCID: PMC3498206 DOI: 10.1371/journal.pone.0049742] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 10/12/2012] [Indexed: 12/20/2022] Open
Abstract
Purpose Patients with ulnar neuropathy of unclear etiology occasionally present with lesion extension from elbow to upper arm level on MRI. This study investigated whether MRI thereby distinguishes multifocal neuropathy from focal-compressive neuropathy at the elbow. Methods This prospective study was approved by the institutional ethics committee and written informed consent was obtained from all participants. 122 patients with ulnar mononeuropathy of undetermined localization and etiology by clinical and electrophysiological examination were assessed by MRI at upper arm and elbow level using T2-weighted fat-saturated sequences at 3T. Twenty-one patients were identified with proximal ulnar nerve lesions and evaluated for findings suggestive of disseminated neuropathy (i) subclinical lesions in other nerves, (ii) unfavorable outcome after previous decompressive elbow surgery, and (iii) subsequent diagnosis of inflammatory or other disseminated neuropathy. Two groups served as controls for quantitative analysis of nerve-to-muscle signal intensity ratios: 20 subjects with typical focal ulnar neuropathy at the elbow and 20 healthy subjects. Results In the group of 21 patients with proximal ulnar nerve lesion extension, T2-w ulnar nerve signal was significantly (p<0.001) higher at upper arm level than in both control groups. A cut-off value of 1.92 for maximum nerve-to-muscle signal intensity ratio was found to be sensitive (86%) and specific (100%) to discriminate this group. Ten patients (48%) exhibited additional T2-w lesions in the median and/or radial nerve. Another ten (48%) had previously undergone elbow surgery without satisfying outcome. Clinical follow-up was available in 15 (71%) and revealed definitive diagnoses of multifocal neuropathy of various etiologies in four patients. In another eight, diagnoses could not yet be considered definitive but were consistent with multifocal neuropathy. Conclusion Proximal ulnar nerve T2 lesions at upper arm level are detected by MRI and indicate the presence of a non-focal disseminated neuropathy instead of a focal compressive neuropathy.
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