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Craniofacial bone alterations in patients with neurofibromatosis type 1

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Abstract

Osseous manifestations of neurofibromatosis 1 (NF-1) occur in a minority of the affected subjects but may be because of significant clinical impairment. Typically, they involve the long bones, commonly the tibia and the fibula, the vertebrae, and the sphenoid wing. The pathogenesis of NF-1 focal osseous lesions and its possible relationships with other osseous NF-1 anomalies leading to short stature are still unknown, though it is likely that they depend on a common mechanism acting in a specific subgroup of NF-1 patients. Indeed, NF-1 gene product, neurofibromin, is expressed in all the cells that participate to bone growth: osteoblasts, osteoclasts, chondrocytes, fibroblasts, and vascular endothelial cells. Absent or low content of neurofibromin may be responsible for the osseous manifestations associated to NF-1. Among the focal NF-1 osseous anomalies, the agenesis of the sphenoid wing is of a particular interest to the neurosurgeon because of its progressive course that can be counteracted only by a surgical intervention. The sphenoid wing agenesis is regarded as a dysplasia, which is a primary bone pathology. However, its clinical progression is related to a variety of causes, commonly the development of an intraorbital plexiform neurofibroma or the extracranial protrusion of temporal lobe parenchyma and its coverings. Thus, the cranial bone defect resulting by the primary bone dysplasia is progressively accentuated by the orbit remodeling caused by the necessity of accommodating the mass effect exerted by the growing tumor or the progression of the herniated intracranial content. The aim of this paper is to review the neurosurgical and craniofacial surgical modalities to prevent the further progression of the disease by “reconstructing” the normal relationship of the orbit and the skull.

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Authors and Affiliations

  1. Department of Pediatric Cranio-Maxillo-Facial Surgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France

    Julie Chauvel-Picard, Christian Paulus & Arnaud Gleizal

  2. Université Claude Bernard Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France

    Julie Chauvel-Picard, Pierre-Aurélien Beuriat, Christian Paulus, Alexandru Szathmari, Carmine Mottolese, Arnaud Gleizal & Federico Di Rocco

  3. French Referral Center for Craniosynostosis and Craniofacial Disorders, Hôpital Femme Mère Enfant, Bron, France

    Julie Chauvel-Picard, Pierre-Aurélien Beuriat, Christian Paulus, Alexandru Szathmari, Carmine Mottolese, Arnaud Gleizal & Federico Di Rocco

  4. Department of Pediatric Neurology, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France

    Laurence Lion-Francois

  5. Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron, France

    Pierre-Aurélien Beuriat, Alexandru Szathmari, Carmine Mottolese & Federico Di Rocco

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Chauvel-Picard, J., Lion-Francois, L., Beuriat, PA. et al. Craniofacial bone alterations in patients with neurofibromatosis type 1. Childs Nerv Syst 36, 2391–2399 (2020). https://doi.org/10.1007/s00381-020-04749-6

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