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Garg S, Wan MW, Begum-Ali J, Kolesnik-Taylor A, Green J, Johnson MH, Jones E. Early Developmental Trajectories in Infants With Neurofibromatosis 1. Front Psychol 2022; 13:795951. [PMID: 35936291 PMCID: PMC9355323 DOI: 10.3389/fpsyg.2022.795951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To examine the trajectories of cognitive, motor and behavioural development in infants with NF1 compared to infants without a family history of neurodevelopmental difficulties. Study design Infants with NF1 and low-risk controls were recruited from 5 months of age and followed longitudinally. Data from standardised tests was gathered at 5, 10 and 14 months and developmental trajectories of motor, language, behaviour, sleep, social development and parent-infant interaction were examined. Linear mixed modelling was used to estimate group differences in cognitive and behavioural measures over time. Results No group differences were observed on Mullen Scale of Early Learning, overall adaptive functioning, temperament or behavioural measures. There were no group differences observed on measures of social communication or parent-infant interaction. Over the course of development, the NF1 group slept less and took more time to settle to sleep as compared to the control group. Maternal education was significantly associated with cognitive and behavioural developmental outcomes in both groups. Conclusion Cognitive, social and behavioural impairments are a cause of significant functional morbidity in children with NF1. This report is the first study to investigate the trajectories of cognitive, motor and behavioural development in infancy in NF1. Our results demonstrate that overall cognitive and behavioural developmental trajectories of the NF1 group in the infancy period are similar to controls. Given previous reports of delayed development in the NF1 cohort by 40 months, early clinical interventions strategies to promote sleep hygiene may be beneficial to optimise developmental outcomes.
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Affiliation(s)
- Shruti Garg
- Division of Neuroscience and Experimental Psychology, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation, Manchester, United Kingdom
| | - Ming Wai Wan
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Jannath Begum-Ali
- Centre for Brain and Cognitive Development and Department of Psychology, Birkbeck, University of London, London, United Kingdom
| | - Anna Kolesnik-Taylor
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation, Manchester, United Kingdom
| | - Mark H. Johnson
- Centre for Brain and Cognitive Development and Department of Psychology, Birkbeck, University of London, London, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Emily Jones
- Centre for Brain and Cognitive Development and Department of Psychology, Birkbeck, University of London, London, United Kingdom
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Permana GI, Parenrengi MA, Suryaningtyas W, Fauziah D, Azzam M. The recurrent plexiform neurofibroma of the scalp in neurofibromatosis type 1: illustrative case. J Neurosurg Case Lessons 2021; 1:CASE2024. [PMID: 35854934 PMCID: PMC9241322 DOI: 10.3171/case2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 10/14/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND Plexiform neurofibroma is a benign tumor of the peripheral nerves. It is an unusual variant of neurofibroma originating from all parts of the nerve. Plexiform neurofibroma is primarily pathognomonic and exhibits an unusual variant from neurofibromatosis type 1 (NF1). The possibility of malignancy and recurrence are the main reasons for long-term, close follow-up. OBSERVATIONS The authors report a case of a 14-year-old girl with a recurrent plexiform neurofibroma derived from the peripheral nerves, which also presented with a typical sign of NF1 disease. The aim of the tumor resection is symptomatic relief. LESSONS Accomplishing a good outcome can be related to good perioperative planning and a precise operative procedure. The result of anatomical pathology determines the prognosis of the patient. Clinical examination and radiological studies are needed to evaluate the recurrence of complications after surgical procedures.
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Affiliation(s)
| | | | | | - Dyah Fauziah
- Pathological Anatomy, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
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Waqar M, Huson S, Evans DG, Ealing J, Karabatsou K, George KJ, Soh C. C2 neurofibromas in neurofibromatosis type 1: genetic and imaging characteristics. J Neurosurg Spine 2019; 30:126-132. [PMID: 30485203 DOI: 10.3171/2018.7.spine171340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 07/10/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVEC2 nerve root neurofibromas have been reported frequently in patients with neurofibromatosis type 1 (NF1), although their genetic and imaging characteristics are unexplored. The aim of this study was to characterize genetic and spinal imaging findings in a large cohort of NF1 patients with C2 neurofibromas.METHODSThe authors performed a review of national NF1 referrals between 2009 and 2016. Inclusion criteria were at least 1 C2 root neurofibroma and cervical-spine or whole-spine MRI scans available for analysis. Blinded imaging review was performed by a neuroradiologist with an interest in NF1.RESULTSFifty-four patients with 106 C2 neurofibromas were included. The median age was 32.5 years (range 15-61 years), and there were slightly more male patients (33 vs 21 female patients). Splice-site (30%) and missense (20%) variants were frequent. Spinal neurofibromas were distributed in all spine regions (65%) or in the cervical spine alone (22%). Most (93%) C2 neurofibromas were visible on MRI scans of the head. Intradural invasion and cord compression in the cervical spine included the C2 level in 95% and 80% of patients, respectively. Compared with all other cervical spine neurofibromas in these patients, C2 neurofibromas had higher rates of intraspinal extension (75% vs 32%; OR 6.20, 95% CI 3.85-9.97; p < 0.001), intradural invasion (53% vs 26%; OR 3.20, 95% CI 2.08-4.92; p < 0.001), and cord compression (25% vs 13%; OR 2.26, 95% CI 1.35-3.79; p = 0.002). However, C2 neurofibromas had lower rates of extraforaminal growth beyond the transverse process (12% vs 62%; OR 0.09, 95% CI 0.05-0.16; p < 0.001).CONCLUSIONSC2 neurofibromas are associated with an aggressive intraspinal phenotype, limited growth outside the spinal canal, and an uncommon genetic profile. These observations require future study.
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Affiliation(s)
- Mueez Waqar
- Departments of1Neurosurgery.,2Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, The University of Manchester, United Kingdom
| | - Susan Huson
- 2Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, The University of Manchester, United Kingdom.,3Department of Neurogenetics, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester; and
| | - D Gareth Evans
- 2Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, The University of Manchester, United Kingdom.,3Department of Neurogenetics, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester; and
| | - John Ealing
- 2Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, The University of Manchester, United Kingdom.,4Neurogenetics, and
| | - Konstantina Karabatsou
- Departments of1Neurosurgery.,2Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, The University of Manchester, United Kingdom
| | - K Joshi George
- Departments of1Neurosurgery.,2Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, The University of Manchester, United Kingdom
| | - Calvin Soh
- 2Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, The University of Manchester, United Kingdom.,5Neuroradiology, Salford Royal NHS Foundation Trust, Salford
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van Baarsen K, Roth J, Serova N, Packer RJ, Shofty B, Thomale UW, Cinalli G, Toledano H, Michowiz S, Constantini S. Optic pathway-hypothalamic glioma hemorrhage: a series of 9 patients and review of the literature. J Neurosurg 2019; 129:1407-1415. [PMID: 29424646 DOI: 10.3171/2017.8.jns163085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/08/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEHemorrhage (also known as apoplexy) in optic pathway gliomas (OPGs) is rare. Because of the variable presentations and low incidence of OPG hemorrhages, little is known about their clinical course and the best treatment options. The aim of this work was to review risk factors, clinical course, and treatment strategies of optic glioma hemorrhages in the largest possible number of cases.METHODSA total of 34 patients were analyzed. Nine new cases were collected, and 25 were identified in the literature. Data regarding demographics, radiological and histological features, treatment, and outcome were retrospectively reviewed.RESULTSThe majority of patients were younger than 20 years. Only 3 patients were known to have neurofibromatosis. The histopathological diagnosis was pilocytic astrocytoma in the majority of cases. Five patients had intraorbital hemorrhages, whereas 29 patients had intracranial hemorrhage; the majority of intracranial bleeds were treated surgically. Six patients, all with intracranial hemorrhage, died due to recurrent bleeding, hydrocephalus, or surgical complications. No clear risk factors could be identified.CONCLUSIONSIntracerebral OPG hemorrhages have a fatal outcome in 20% of cases. Age, hormonal status, neurofibromatosis involvement, and histopathological diagnosis have been suggested as risk factors for hemorrhage, but this cannot be reliably established from the present series. The goals of surgery should be patient survival and prevention of further neurological and ophthalmological deterioration.
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Affiliation(s)
- Kirsten van Baarsen
- 1Department of Pediatric Neurosurgery, International Israel Neurofibromatosis Center (IINFC), Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Israel.,2Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jonathan Roth
- 1Department of Pediatric Neurosurgery, International Israel Neurofibromatosis Center (IINFC), Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Israel
| | - Natalia Serova
- 3Department of Neuro-ophthalmology, Burdenko Neurosurgical Institute, Moscow, Russia
| | - Roger J Packer
- 4Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington, DC
| | - Ben Shofty
- 1Department of Pediatric Neurosurgery, International Israel Neurofibromatosis Center (IINFC), Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Israel
| | - Ulrich-W Thomale
- 5Department of Pediatric Neurosurgery, Charité Universitätsmedizin, Berlin, Germany
| | - Giuseppe Cinalli
- 6Department of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy; and
| | - Helen Toledano
- Departments of7Pediatric Oncology and.,8Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Shalom Michowiz
- 8Sackler Faculty of Medicine, Tel Aviv University, Israel.,9Pediatric Neurosurgery, Schneider Children's Medical Center of Israel, Petach Tikva; and
| | - Shlomi Constantini
- 1Department of Pediatric Neurosurgery, International Israel Neurofibromatosis Center (IINFC), Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Israel
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Sebai MA, Kerezoudis P, Alvi MA, Yoon JW, Spinner RJ, Bydon M. Need for arthrodesis following facetectomy for spinal peripheral nerve sheath tumors: an institutional experience and review of the current literature. J Neurosurg Spine 2019; 31:112-122. [PMID: 30952137 DOI: 10.3171/2019.1.spine181057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/08/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Spinal peripheral nerve sheath tumors (PNSTs) are a group of rare tumors originating from the nerve and its supporting structures. Standard surgical management typically entails laminectomy with or without facetectomy to gain adequate tumor exposure. Arthrodesis is occasionally performed to maintain spinal stability and mitigate the risk of postoperative deformity, pain, or neurological deficit. However, the factors associated with the need for instrumentation in addition to PNST resection in the same setting remain unclear. METHODS An institutional tumor registry at a tertiary care center was queried for patients treated surgically for a primary diagnosis of spinal PNST between 2002 and 2016. An analysis focused on patients in whom a facetectomy was performed during the resection. The addition of arthrodesis at the index procedure comprised the primary outcome. The authors also recorded baseline demographics, tumor characteristics, and surgery-related variables. Logistic regression was used to identify factors associated with increased risk of fusion surgery. RESULTS A total of 163 patients were identified, of which 56 (32 had facetectomy with fusion, 24 had facetectomy alone) were analyzed. The median age was 48 years, and 50% of the cohort was female. Age, sex, and race, as well as tumor histology and size, were evenly distributed between patients who received facetectomy alone and those who had facetectomy and fusion. On univariate analysis, total versus subtotal facetectomy (OR 9.0, 95% CI 2.01-64.2; p = 0.009) and cervicothoracic versus other spinal region (OR 9.0, 95% CI 1.51-172.9; p = 0.048) were significantly associated with increased odds of performing immediate fusion. On multivariable analysis, only the effect of total facetectomy remained statistically significant (OR 6.75, 95% CI 1.47-48.8; p = 0.025). CONCLUSIONS The authors found that total facetectomy and cervicothoracic involvement may be highly associated with the need for concomitant arthrodesis at the time of index surgery. These findings may help surgeons to determine the best surgical planning for patients with PNST.
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Affiliation(s)
- Mohammed Adeeb Sebai
- 1Mayo Clinic Neuro-Informatics Laboratory, and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Panagiotis Kerezoudis
- 1Mayo Clinic Neuro-Informatics Laboratory, and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Mohammed Ali Alvi
- 1Mayo Clinic Neuro-Informatics Laboratory, and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Jang Won Yoon
- 1Mayo Clinic Neuro-Informatics Laboratory, and
- 3Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Robert J Spinner
- 1Mayo Clinic Neuro-Informatics Laboratory, and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Mohamad Bydon
- 1Mayo Clinic Neuro-Informatics Laboratory, and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and
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Pollack IF, Agnihotri S, Broniscer A. Childhood brain tumors: current management, biological insights, and future directions. J Neurosurg Pediatr 2019; 23:261-273. [PMID: 30835699 PMCID: PMC6823600 DOI: 10.3171/2018.10.peds18377] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/29/2018] [Indexed: 02/06/2023]
Abstract
Brain tumors are the most common solid tumors in children, and, unfortunately, many subtypes continue to have a suboptimal long-term outcome. During the last several years, however, remarkable advances in our understanding of the molecular underpinnings of these tumors have occurred as a result of high-resolution genomic, epigenetic, and transcriptomic profiling, which have provided insights for improved tumor categorization and molecularly directed therapies. While tumors such as medulloblastomas have been historically grouped into standard- and high-risk categories, it is now recognized that these tumors encompass four or more molecular subsets with distinct clinical and molecular characteristics. Likewise, high-grade glioma, which for decades was considered a single high-risk entity, is now known to comprise multiple subsets of tumors that differ in terms of patient age, tumor location, and prognosis. The situation is even more complex for ependymoma, for which at least nine subsets of tumors have been described. Conversely, the majority of pilocytic astrocytomas appear to result from genetic changes that alter a single, therapeutically targetable molecular pathway. Accordingly, the present era is one in which treatment is evolving from the historical standard of radiation and conventional chemotherapy to a more nuanced approach in which these modalities are applied in a risk-adapted framework and molecularly targeted therapies are implemented to augment or, in some cases, replace conventional therapy. Herein, the authors review advances in the categorization and treatment of several of the more common pediatric brain tumors and discuss current and future directions in tumor management that hold significant promise for patients with these challenging tumors.
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