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Dingenen E, Segers D, De Maeseneer H, Van Gysel D. Sturge-Weber syndrome: an update for the pediatrician. World J Pediatr 2024; 20:435-443. [PMID: 38658498 DOI: 10.1007/s12519-024-00809-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/27/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Sturge-Weber syndrome (SWS) is a rare congenital neurocutaneous disorder characterized by the simultaneous presence of both cutaneous and extracutaneous capillary malformations. SWS usually presents as a facial port-wine birthmark, with a varying presence of leptomeningeal capillary malformations and ocular vascular abnormalities. The latter may lead to significant neurological and ocular morbidity such as epilepsy and glaucoma. SWS is most often caused by a somatic mutation involving the G protein subunit alpha Q or G protein subunit alpha 11 gene causing various alterations in downstream signaling pathways. We specifically conducted a comprehensive review focusing on the current knowledge of clinical practices, the latest pathophysiological insights, and the potential novel therapeutic avenues they provide. DATA SOURCES A narrative, non-systematic review of the literature was conducted, combining expert opinion with a balanced review of the available literature. A search of PubMed, Google Scholar and Embase was conducted, using keywords "Sturge-Weber Syndrome" OR "SWS", "Capillary malformations", "G protein subunit alpha 11" OR "G protein subunit alpha Q". RESULTS One of the hallmark features of SWS is the presence of a port-wine birthmark at birth, and forehead involvement is most indicative for SWS. The most common ocular manifestations of SWS are glaucoma and choroidal hemangioma. Glaucoma presents in either in infancy (0-3 years of age) or later in life. Neurological complications are common in SWS, occurring in about 70%-80% of patients, with seizures being the most common one. SWS significantly impacts the quality of life for patients and their families, and requires a multidisciplinary approach for diagnosis and treatment. Currently, no disease-modifying therapies exist, and treatment is mostly focused on symptoms or complications as they arise. CONCLUSIONS: SWS remains a complex and heterogeneous disorder. Further research is needed to optimize diagnostic and therapeutic strategies, and to translate insights from molecular pathogenesis to clinical practice.
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Affiliation(s)
- Emilie Dingenen
- Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Damien Segers
- Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Hannelore De Maeseneer
- Department of Pediatrics, O.L.Vrouw Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - Dirk Van Gysel
- Department of Pediatrics, O.L.Vrouw Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium.
- Interdisciplinary Unit of Pediatric Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
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Hoang TT, Do HD, Do HT, Nguyen CN, Alward WLM. Bilateral Blood Reflux Into Schlemm Canals Caused by a Unilateral Dural Sinus Arteriovenous Fistula in a Patient With Cerebral Venous Thrombosis. J Neuroophthalmol 2023; 43:e288-e290. [PMID: 34924532 DOI: 10.1097/wno.0000000000001419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tung Thanh Hoang
- Department of Ophthalmology (TTH, HDD), Hanoi Medical University, Hanoi, Vietnam; Ophthalmology Unit (TTH, HDD, HTD), Hanoi Medical University Hospital, Hanoi, Vietnam; Save Sight Institute (TTH), The University of Sydney School of Medicine, Sydney, Australia ; Radiology Center (CNN), Hanoi Medical University Hospital, Hanoi,Vietnam; and Department of Ophthalmology and Visual Sciences (WLMA), University of Iowa Carver College of Medicine, Iowa City, Iowa
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Wang X, Wang M, Liu H, Mercieca K, Prinz J, Feng Y, Prokosch V. The Association between Vascular Abnormalities and Glaucoma-What Comes First? Int J Mol Sci 2023; 24:13211. [PMID: 37686017 PMCID: PMC10487550 DOI: 10.3390/ijms241713211] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Glaucoma is a leading cause of irreversible blindness worldwide. While intraocular pressure (IOP) presents a major risk factor, the underlying pathophysiology still remains largely unclear. The correlation between vascular abnormalities and glaucoma has been deliberated for decades. Evidence for a role played by vascular factors in the pathogenesis of glaucomatous neurodegeneration has already been postulated. In addition, the fact that glaucoma causes both structural and functional changes to retinal blood vessels has been described. This review aims to investigate the published evidence concerning the relationship between vascular abnormalities and glaucoma, and to provide an overview of the "chicken or egg" dilemma in glaucoma. In this study, several biomarkers of glaucoma progression from a vascular perspective, including endothelin-1 (ET-1), nitric oxide, vascular endothelial growth factor (VEGF), and matrix metalloproteinases (MMPs), were identified and subsequently assessed for their potential as pharmacological intervention targets.
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Affiliation(s)
- Xiaosha Wang
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
| | - Maoren Wang
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Hanhan Liu
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
| | - Karl Mercieca
- Glaucoma Section, University Hospital Eye Clinic, 53127 Bonn, Germany;
- Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester M13 9WH, UK
| | - Julia Prinz
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
- Department of Ophthalmology, RWTH Aachen University, 52074 Aachen, Germany
| | - Yuan Feng
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
| | - Verena Prokosch
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
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Zhang X, Hu Y, Li D, Qian X, Xu Y, Guo M, Li Q. Isolated diffuse choroidal hemangioma without systemic symptoms: a case report. BMC Ophthalmol 2023; 23:300. [PMID: 37407944 DOI: 10.1186/s12886-023-03057-2] [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: 09/07/2022] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Sturge-Weber syndrome is a nonhereditary congenital neurocutaneous syndrome characterized by a distinctive facial capillary malformation,neurological abnormalities, and ocular abnormalities such as glaucoma and choroidal hemangioma.It can be divided into different subtypes according to different clinical manifestations. It is rare for a patient to present with isolated difuse choroidal hemangioma and ipsilateral abnormal conjunctival and episcleral vessels without other systemic symptoms. CASE PRESENTATION We report a 30-year-old man with isolated diffuse choroidal hemangioma in his right eye without systemic symptoms, such as vascular malformations in the skin or leptomeningeal angiomatosis. The only additional ophthalmic finding was ipsilateral abnormal conjunctival and episcleral vessels without glaucoma. However, there was no evidence of leptomeningeal angiomatosis or port-wine stain on the right side of the face, or glaucoma, which are common clinical manifestations of the Sturge-Weber syndrome (SWS).The absence of these characteristic symptoms did not preclude the diagnosis, and the patient could be diagnosed with a particular subtype of SWS. CONCLUSIONS This is a rare case of documented isolated difuse choroidal hemangioma with ipsilateral abnormal conjunctival and episcleral vessels without glaucoma which we think it is belonging to a particular subtype of SWS.In addition to the traditional clinical manifestations, more and more atypical clinical manifestations are also accompanied by SWS, which requires our clinicians to continuously discover and report, so as to help more clinicians understand this disease.
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Affiliation(s)
- Xiaohua Zhang
- Department of Ophthalmology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Yongping Hu
- Department of Ophthalmology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Di Li
- Department of Ophthalmology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoxiao Qian
- Department of Ophthalmology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yongning Xu
- Department of Ophthalmology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Man Guo
- Department of Ophthalmology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qihang Li
- Department of Ophthalmology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Sánchez-Espino LF, Ivars M, Antoñanzas J, Baselga E. Sturge-Weber Syndrome: A Review of Pathophysiology, Genetics, Clinical Features, and Current Management Approache. Appl Clin Genet 2023; 16:63-81. [PMID: 37124240 PMCID: PMC10145477 DOI: 10.2147/tacg.s363685] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/10/2023] [Indexed: 05/02/2023] Open
Abstract
Sturge-Weber syndrome (SWS) is a congenital, sporadic, and rare neurocutaneous disorder, characterized by the presence of a facial port-wine birthmark (PWB), glaucoma, and neurological manifestations including leptomeningeal angiomatosis and seizures. It is caused by a postzygotic, somatic, gain-of-function variant of the GNAQ gene, and more recently, the GNA11 gene in association with distinctive clinical features. Neuroimaging can help identify and stratify patients at risk for significant complications allowing closer follow-up; although no presymptomatic treatment has been demonstrated to be effective to date, these patients could benefit from early treatment and/or supportive interventions. Choroid plexus (CP) thickness measurements in brain magnetic resonance imaging (MRI) have a high sensitivity and specificity for early and incipient changes in SWS. In contrast, the absence of pathologic findings makes it possible to rule out associated neurological involvement and leads to periodical observation, with new imaging studies only in cases of new clinical signs/symptoms. Periodic ophthalmological examination is also recommended every 3 months during the first year and yearly afterwards to monitor for glaucoma and choroidal hemangiomas. Treatment for SWS depends on the extent and areas that are affected. These include laser surgery for PWB, anticonvulsants in the case of brain involvement, with either seizures or abnormal EEG, and medical treatment or surgery for glaucoma. Sirolimus has been used in a limited number of patients and appears to be a safe and potentially effective treatment for cutaneous and extra-cutaneous features, however controlled clinical studies have not been carried out. Better knowledge of GNAQ/GNA11 molecular pathways will help to develop future targeted treatments.
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Affiliation(s)
| | - Marta Ivars
- Pediatric Dermatology Department, Barcelona Children’s Hospital Sant Joan de Dèu, Barcelona, Cataluña, Spain
| | - Javier Antoñanzas
- Dermatology Department, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Eulalia Baselga
- Pediatric Dermatology Department, Barcelona Children’s Hospital Sant Joan de Dèu, Barcelona, Cataluña, Spain
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Cao J, Yang G, Xu S, Tang P, Wang Y, Shan Y, Chen Y, He P. Clinicopathological Analysis of Sturge-Weber Syndrome with Focal Cortical Dysplasia FCD IIIc. Fetal Pediatr Pathol 2023:1-12. [PMID: 36734681 DOI: 10.1080/15513815.2023.2171749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: To investigate the clinicopathological features of children with Sturge-Weber syndrome and to analyze the correlation between the distribution area of leptomeningeal angiomatosis, the degree of cerebral cortical calcification, and the degree of cerebral atrophy associated with epileptic seizures. Methods: 10 children were diagnosed with SWS with FCD IIIc by histopathology and immunohistochemistry. Spearman correlation analysis was used to calculate the association of SWS with FCD IIIc and seizures in children. Results: The leptomeningeal angiomatosis area was markedly positively correlated with the degree of brain atrophy in 10 children with SWS (r = 0.783, p = 0.007). The distribution of leptomeningeal hemangiomatosis, the degree of cortical calcification, and brain atrophy were not significantly correlated with epilepsy. Conclusion: SWS may be accompanied by FCD IIIc. The more extensive the cerebral lobes of leptomeningeal angiomatosis in SWS, the more pronounced the brain atrophy.
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Affiliation(s)
- Juan Cao
- Department of Pathology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Guocheng Yang
- Department of Pathology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Shoujun Xu
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Pengyue Tang
- Department of Dermatology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Yue Wang
- Department of Pathology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Yingying Shan
- Department of Pathology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Yongxian Chen
- Department of Pathology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Peng He
- Department of Pathology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
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Diao P, Han C, Li X, Yang Y, Jiang X. Hematoporphyrin Monomethyl Ether Photodynamic Therapy of Port Wine Stain: Narrative Review. Clin Cosmet Investig Dermatol 2023; 16:1135-1144. [PMID: 37139084 PMCID: PMC10150768 DOI: 10.2147/ccid.s401447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/20/2023] [Indexed: 05/05/2023]
Abstract
Port wine stain (PWS) is a congenital and progressive capillary malformation characterized by structural abnormalities of intradermal capillaries and postcapillary venules. The visible manifestation is often considered a disfigurement and the accompanying social stigma often causes serious emotional and physical impact. Hematoporphyrin monomethyl ether (HMME) is a newly authorized photosensitizer for treating PWS in China. Hematoporphyrin monomethyl ether photodynamic therapy (HMME-PDT) has successfully treated thousands of Chinese patients with PWS since 2017, and HMME-PDT may be one of the most promising strategies for the treatment of PWS. However, there are few reviews published about the clinical use of HMME-PDT. So in this article, we want to briefly review the mechanism, efficacy evaluation, effectiveness and influencing factors, and the common postoperative reactions and treatment suggestions of HMME-PDT in the treatment of PWS.
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Affiliation(s)
- Ping Diao
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Chenglong Han
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Xiaoxue Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Yi Yang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China
- Correspondence: Xian Jiang, Email
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Pouliquen G, Fillon L, Dangouloff-Ros V, Kuchenbuch M, Bar C, Chemaly N, Levy R, Roux CJ, Saitovitch A, Boisgontier J, Nabbout R, Boddaert N. Arterial Spin-Labeling Perfusion Imaging in the Early Stage of Sturge-Weber Syndrome. AJNR Am J Neuroradiol 2022; 43:1516-1522. [PMID: 36137664 PMCID: PMC9575527 DOI: 10.3174/ajnr.a7643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 07/27/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Sturge-Weber syndrome is a rare congenital neuro-oculo-cutaneous disorder. Although the principal mechanism of Sturge-Weber syndrome is characterized by a leptomeningeal vascular malformation, few data regarding perfusion abnormalities of the brain parenchyma are available. Therefore, the aim of this study was to assess the diagnostic performance of arterial spin-labeling perfusion imaging in the early stage of Sturge-Weber syndrome before 1 year of age until 3.5 years of age. We hypothesized that a leptomeningeal vascular malformation has very early hypoperfusion compared with controls with healthy brains. MATERIALS AND METHODS We compared the CBF using arterial spin-labeling perfusion imaging performed at 3T MR imaging in the brain parenchymal regions juxtaposing the leptomeningeal vascular malformation in patients with Sturge-Weber syndrome (n = 16; 3.5 years of age or younger) with the corresponding areas in age-matched controls with healthy brains (n = 58). The analysis was performed following two complementary methods: a whole-brain voxel-based analysis and a visual ROI analysis focused on brain territory of the leptomeningeal vascular malformation. RESULTS Whole-brain voxel-based comparison revealed a significant unilateral decrease in CBF localized in the affected cortices of patients with Sturge-Weber syndrome (P < .001). CBF values within the ROIs in patients with Sturge-Weber syndrome were lower than those in controls (in the whole cohort: median, 25 mL/100g/min, versus 44 mL/100g/min; P < .001). This finding was also observed in the group younger than 1 year of age, emphasizing the high sensitivity of arterial spin-labeling in this age window in which the diagnosis is difficult. CONCLUSIONS Arterial spin-labeling perfusion imaging in the early stage of Sturge-Weber syndrome can help to diagnose the disease by depicting a cortical hypoperfusion juxtaposing the leptomeningeal vascular malformation.
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Affiliation(s)
- G Pouliquen
- From the Department of Pediatric Radiology (G.P., V.D.-R., R.L., C.-J.R., N.B.)
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
| | - L Fillon
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
| | - V Dangouloff-Ros
- From the Department of Pediatric Radiology (G.P., V.D.-R., R.L., C.-J.R., N.B.)
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
| | - M Kuchenbuch
- Centre de Reference Epilepsies Rares (M.K., C.B., N.C., R.N.), Department of Pediatric Neurology, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - C Bar
- Centre de Reference Epilepsies Rares (M.K., C.B., N.C., R.N.), Department of Pediatric Neurology, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - N Chemaly
- Centre de Reference Epilepsies Rares (M.K., C.B., N.C., R.N.), Department of Pediatric Neurology, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - R Levy
- From the Department of Pediatric Radiology (G.P., V.D.-R., R.L., C.-J.R., N.B.)
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
| | - C-J Roux
- From the Department of Pediatric Radiology (G.P., V.D.-R., R.L., C.-J.R., N.B.)
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
| | - A Saitovitch
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
| | - J Boisgontier
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
| | - R Nabbout
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
- Centre de Reference Epilepsies Rares (M.K., C.B., N.C., R.N.), Department of Pediatric Neurology, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - N Boddaert
- From the Department of Pediatric Radiology (G.P., V.D.-R., R.L., C.-J.R., N.B.)
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
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Coexistence of Neonatal Lupus Erythematous and Sturge-Weber Syndrome. Case Rep Dermatol Med 2022; 2021:3616429. [PMID: 35003813 PMCID: PMC8736701 DOI: 10.1155/2021/3616429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/04/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022] Open
Abstract
Neonatal lupus erythematous (NLE) is a rare condition presented by lupus dermatitis shortly after birth or later following sun exposure. Sturge–Weber syndrome (SWS) is also an uncommon congenital condition characterized by extensive capillary malformation and ophthalmic and/or neurologic involvement. Here, we describe the first case of coexistence of NLE and SWS which posed a significant diagnostic challenge to clinicians.
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Wang S, Pan J, Zhao M, Wang X, Zhang C, Li T, Wang M, Wang J, Zhou J, Liu C, Sun Y, Zhu M, Qi X, Luan G, Guan Y. Characteristics, surgical outcomes, and influential factors of epilepsy in Sturge-Weber syndrome. Brain 2021; 145:3431-3443. [PMID: 34932802 DOI: 10.1093/brain/awab470] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/19/2021] [Accepted: 11/28/2021] [Indexed: 02/05/2023] Open
Abstract
Abstract
Few studies have reported the clinical presentation, surgical treatment, outcomes, and influential factors for patients with epilepsy and Sturge-Weber syndrome.
This large-scale retrospective study continuously enrolled 132 patients with Sturge-Weber syndrome and epilepsy from January 2008 to December 2018 at our hospital to analyze their characteristics. Among these patients, 90 underwent epilepsy surgery, and their postoperative 2-year follow-up seizure, cognitive, and motor functional outcomes were assessed and analyzed. Univariable and multivariable logistic analyses were conducted to explore the influential factors.
Among the Sturge-Weber syndrome patients for whom characteristics were analyzed (n = 132), 76.52% of patients had their first epileptic seizures within their first year of life. The risk factors for cognitive decline were seizure history≥2 years (adjusted odds ratio [aOR] = 3.829, 95% confidence interval [CI]: 1.810-9.021, p = 0.008), bilateral leptomeningeal angiomas (aOR = 3.173, 95% CI: 1.970-48.194, p = 0.013), age at onset < 1 year (aOR = 2.903, 95% CI: 1.230-6.514, p = 0.013), brain calcification (aOR = 2.375, 95% CI: 1.396-5.201, p = 0.021) and left leptomeningeal angiomas (aOR = 2.228, 95% CI: 1.351-32.571, p = 0.030). Of the patients who underwent epilepsy surgery (n = 90), 44 were subject to focal resection, and 46 underwent hemisphere surgery (19 anatomical hemispherectomies and 27 modified hemispherotomies). A postoperative seizure-free status, favorable cognitive outcomes, and favorable motor outcomes were achieved in 83.33%, 44.44%, and 43.33% of surgical patients, respectively. The modified hemispherotomy group had similar surgical outcomes, less intraoperative blood loss and shorter postoperative hospital stays than the anatomical hemispherectomy group. Regarding seizure outcomes, full resection (aOR = 11.115, 95% CI: 1.260-98.067, p = 0.020) and age at surgery < 2 years (aOR = 6.040, 95% CI: 1.444-73.367, p = 0.031) were positive influential factors for focal resection. Age at surgery < 2 years (aOR = 15.053, 95% CI: 1.050-215.899, p = 0.036) and infrequent seizures (aOR = 8.426, 95% CI: 1.086-87.442, p = 0.042; monthly vs. weekly) were positive influential factors for hemisphere surgery.
In conclusion, epilepsy surgery resulted in a good postoperative seizure-free rate and favorable cognitive and motor functional outcomes and showed acceptable safety for patients with epilepsy and Sturge-Weber syndrome. Modified hemispherotomy is a less invasive and safer type of hemisphere surgery than traditional anatomic hemispherectomy with similar surgical outcomes. Early surgery may be helpful to achieve better seizure outcomes and cognitive protection, while the risk of surgery for young children should also be considered.
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Affiliation(s)
- Shu Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Junhong Pan
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Meng Zhao
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Xiongfei Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Chunsheng Zhang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Tianfu Li
- Department of Neurology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
- Beijing Key Laboratory of Epilepsy, Beijing 100093, China
- Center of Epilepsy, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100093, China
| | - Mengyang Wang
- Department of Neurology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Jing Wang
- Department of Neurology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Jian Zhou
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Changqing Liu
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Yongxing Sun
- Department of Anesthesiology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Mingwang Zhu
- Department of Radiology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
- Department of Pathology, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
| | | | - Guoming Luan
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
- Beijing Key Laboratory of Epilepsy, Beijing 100093, China
- Center of Epilepsy, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100093, China
| | - Yuguang Guan
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China
- Beijing Key Laboratory of Epilepsy, Beijing 100093, China
- Center of Epilepsy, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing 100093, China
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11
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Helmi HA, Alkatan HM, Al-Essa RS, Aljudi TW, Maktabi AMY, Eberhart CG. Choroidal hemangioma in Sturge Weber syndrome: Case series with confirmed tissue diagnosis. Int J Surg Case Rep 2021; 89:106626. [PMID: 34847393 PMCID: PMC8639421 DOI: 10.1016/j.ijscr.2021.106626] [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: 10/25/2021] [Revised: 11/20/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Sturge-weber syndrome (SWS) is a rare condition that presents with a typical facial port-wine stain, neurological manifestations such as seizures, and ocular involvement by glaucoma and/or choroidal hemangioma. In this series we demonstrate the histopathological details of the primary ocular involvement as well as the late blinding secondary ocular changes. Presentation of cases Seven cases were included with the diagnosis of choroidal hemangioma in association with SWS (6 enucleations and one evisceration). Male to female ratio was 4:3. Age at enucleation/evisceration ranged from 25 to 68 years with a median of 42 years. Five cases had history of glaucoma (71.4%). Diffuse hemangioma was found in all (4 cavernous and 3 mixed cavernous/capillary type). Conjunctival and episcleral hemangiomas were found in 3/7. Iris neovascularization and retinal detachment were confirmed in 5/7 cases each (71%). Discussion Our demographic and histopathological findings parallel what was previously concluded in the literature about the lack of gender predilection in SWS, and the most common ocular presentations of glaucoma and choroidal hemangioma, which is mostly diffuse in nature. The hemangioma type was found to be mostly cavernous followed by mixed capillary and cavernous. We demonstrated late associated ocular changes such as cataract, iris neovascularization, exudative retinal detachment, retinal pigment epithelium hyperplasia/metaplasia, and optic nerve atrophy, all of which aid in the poor visual outcome in these patients. Conclusion Sturge-weber syndrome is a rare but visually disabling disease due to the associated ocular manifestations of glaucoma and choroidal hemangioma. Multidisciplinary approach because of the diverse presentation of this condition by pediatrician, neurologist, and ophthalmologist is essential with an attempt to preserve vision. Sturge-weber syndrome (SWS) is a rare, condition manifesting with port-wine stains, seizures, glaucoma, and hemangiomas. Diffuse choroidal hemangioma (DCH) is the typical ocular lesion in SWS. We report 7 cases with histologically confirmed SWS-associated DCHs and their relevant visually disabling complications. Early diagnosis and treatment are essential for improved visual outcome.
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Affiliation(s)
- Hala A Helmi
- Ophthalmology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Ophthalmology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pathology and Laboratory Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Rakan S Al-Essa
- Ophthalmology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Talal W Aljudi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Azza M Y Maktabi
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Charles G Eberhart
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA; Department of Oncology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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12
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Glaser TS, Meekins LC, Freedman SF. Outcomes and lessons learned from two decades' experience with glaucoma drainage device implantation for refractory Sturge Weber-associated childhood glaucoma. J AAPOS 2021; 25:332.e1-332.e6. [PMID: 34655770 DOI: 10.1016/j.jaapos.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/23/2021] [Accepted: 05/23/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate glaucoma drainage device (GDD) implantation for refractory pediatric glaucoma associated with Sturge-Weber syndrome (SWS). METHODS The medical records of consecutive children with SWS-associated glaucoma at a single center who were treated by a single surgeon using GDDs over 20 years were reviewed retrospectively. The main outcome measure was GDD treatment success, defined as absence of any of the following indications of treatment failure: (1) intraocular pressure (IOP) of >21 mm Hg on two consecutive visits despite maximal medical therapy, (2) additional IOP-lowering surgery, and (3) sight-threatening complications. RESULTS A total of 22 eyes of 22 children were included. The median age at glaucoma diagnosis was 0.73 years (range, 0.06-13.2), and the median age at GDD surgery was 4.8 years (range, 0.6-13.3). Most eyes (14 [68%]) had prior glaucoma surgery. Mean follow-up was 2.8 ± 1.5 years. Success (95% confidence interval) by Kaplan-Meier analysis for GDD surgery at 1, 3, and 5 years was 91% (68-98), 75% (50-89), and 52% (24-73), respectively. Failure occurred in 8 eyes (36%). Complications were common, occurring in 50% of eyes, with 23% of eyes having more than one complication. Severe vision-threatening complications (n = 3) included one case each of possible infection requiring GDD removal, persistent hypotony, and cilioretinal artery occlusion. CONCLUSIONS GDDs are an effective treatment for SWS-associated glaucoma but have a high rate of complications. We report several severe complications that prompted surgical modifications for increased safety when implanting GDDs in eyes with SWS-associated glaucoma.
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Affiliation(s)
- Tanya S Glaser
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
| | - Landon C Meekins
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
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13
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Bertino F, Trofimova AV, Gilyard SN, Hawkins CM. Vascular anomalies of the head and neck: diagnosis and treatment. Pediatr Radiol 2021; 51:1162-1184. [PMID: 33860862 DOI: 10.1007/s00247-021-04968-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/27/2020] [Accepted: 01/07/2021] [Indexed: 01/19/2023]
Abstract
Vascular malformations and vascular tumors comprise the two specific subsets of vascular anomalies that arise as a result of disorganized angiogenesis and neoplasm, respectively. Malformations are separate entities from vascular tumors (e.g., hemangiomas) and are recognized by the International Society for the Study of Vascular Anomalies (ISSVA) as such. Vascular malformations are classified into four main groups: simple, combined, anomalies of major vessels, and those associated with other vascular anomalies. Vascular tumors are neoplastic growths of blood vessels and are morphologically and molecularly distinct from malformations but can arise in the head and neck and have syndromic association. Head and neck vascular anomalies are not uncommon in the pediatric population and require special care in the workup, diagnostic imaging and clinical care. The purpose of this manuscript is to discuss the diagnosis and management of the most common intracranial and extracranial vascular malformations and tumors in the head and neck in children and adolescents.
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Affiliation(s)
- Frederic Bertino
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA.
| | - Anna V Trofimova
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA
| | - Shenise N Gilyard
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA
| | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA.,Division of Pediatric Radiology, Division of Interventional Radiology and Image Guided Medicine, Children's Healthcare of Atlanta, Emory + Children's Pediatric Institute, Atlanta, GA, USA
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14
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Toris CB, Gagrani M, Ghate D. Current methods and new approaches to assess aqueous humor dynamics. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1902308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Carol B. Toris
- Dept. Of Ophthalmology and Visual Science, University of Nebraska Medical Center, Omaha, NE, USA
- Dept. Of Ophthalmology and Visual Science, Case Western Reserve University, Cleveland, OH USA
| | - Meghal Gagrani
- Dept. Of Ophthalmology and Visual Science, University of Nebraska Medical Center, Omaha, NE, USA
| | - Deepta Ghate
- Dept. Of Ophthalmology and Visual Science, University of Nebraska Medical Center, Omaha, NE, USA
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15
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Wang H, Dong N, Tan L, Huang C. Sturge-Weber syndrome coexisting with polydactyly: a case report. BMC Ophthalmol 2021; 21:6. [PMID: 33407220 PMCID: PMC7788809 DOI: 10.1186/s12886-020-01761-x] [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: 09/14/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sturge-Weber syndrome (SWS) is a sporadic congenital disorder, characterized by unilateral facial nevus flammeus associated with ipsilateral glaucoma, choroidal angioma and leptomeningeal hemangiomas. SWS can comorbid with other disorders in some patients, however, there has been no prior described case of SWS and polydactyly occurring in the same patient. CASE PRESENTATION A 15-year-old girl with diagnosis of SWS presented to our hospital. She had bilateral glaucoma and extensive port-wine stains distributing in bilateral faces, left neck and left upper limb. Meanwhile, the patient was noted to demonstrate the superfluous digit attaching on the left thumb and was diagnosed as polydactyly. Trabeculectomy, with intraoperative application of mitomycin C and postoperative subconjunctival injections of 5-fluorouracil, was successful in controlling the intraocular pressure in both eyes. CONCLUSIONS We report a case with bilateral SWS coexisting with unilateral polydactyly, which, to our knowledge, has not been recognized previously and adds further evidence to the existing literature. In view of the rare concurrence of SWS and polydactyly, the etiology is unclear and further investigation is required to explore the underlying pathogenesis.
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Affiliation(s)
- Hongxi Wang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, Guangdong, China
| | - Nana Dong
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, Guangdong, China
| | - Li Tan
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, Guangdong, China
| | - Chukai Huang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, Guangdong, China.
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16
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Sturge-Weber syndrome: an update on the relevant issues for neurosurgeons. Childs Nerv Syst 2020; 36:2553-2570. [PMID: 32564157 DOI: 10.1007/s00381-020-04695-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/21/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Sturge-Weber syndrome (SWS) is a neurocutaneous facomatosis characterized by facial and leptomeningeal angioma, glaucoma, seizures, and neurological disability. Therefore, a challenging multidisciplinary interaction is required for its management. The goal of this paper is to review the main aspects of SWS and to present an illustrative pediatric series. METHODS The pertinent literature has been analyzed, focused mainly on etiopathogenesis, pathology, clinical features, diagnostic tools, management, and outcome of the disease. Moreover, a series of 11 children operated on for refractory epilepsy between 2005 and 2015 (minimum follow-up 5 years, mean follow-up 9.6 years) is reported. The series consists of six boys and five girls with 6.5-month and 16.2-month mean age at seizure onset and at surgery, respectively. Seizures affected all children, followed by hemiparesis and psychomotor delay (81%), glaucoma (54%), and other neurological deficits (45%). RESULTS All children underwent hemispherectomy (anatomical in three cases, functional in two cases, hemispherotomy in six cases); one patient needed a redo hemispherotomy. Mortality was nil; disseminated intravascular coagulation and interstitial pneumonia occurred in one patient each; three children had subdural fluid collection. Eight patients (72%) are in the ILAE Class 1 (completely seizure and aura free), two in Class 2 (only auras, no seizure), and one in Class 3 (1-3 seizure days per year). AEDs discontinuation was possible in 73% of cases. The most important news from the literature concerned the pathogenesis (role of the mutation of the GNAQ gene in the abnormal SWS vasculogenesis), the clinical findings (the features and pathogenesis of the stroke-like episodes are being understood), the diagnostic tools (quantitative MRI and EEG), and both the medical (migraine, seizures) and surgical management (epilepsy). The epileptic outcome of SWS patients is very good (80% are seizure-free), if compared with other hemispheric syndromes. The quality of life is affected by the neurological and cognitive deficits. CONCLUSIONS SWS still is an etiological and clinical challenge. However, the improvements over the time are consistent. In particular, the neurosurgical treatment of refractory epilepsy provides very good results as long as the indication to treatment is correct.
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