Pediatric neurofibromatosis type 2: clinical and molecular presentation, management of vestibular schwannomas, and hearing rehabilitation

Abstract

This study aims to describe the clinical and molecular presentation of pediatric neurofibromatosis type 2 (NF2) and the subsequent management of vestibular schwannomas (VS) and hearing rehabilitation. This is a single-center retrospective study of neurofibromatosis type 2 diagnosed before the age of 18years old from 1997. Natural history of vestibular schwannomas and surgical outcomes were evaluated using volumetric MRI, hearing, and facial nerve assessment. Patients included in chemotherapy protocols were excluded. From a database of 80 patients followed up for NF2 on a regular basis, 25 patients were eligible (11 sporadic cases, 14 inherited in five families). The mean age at diagnosis was 11.6years old. The average clinical follow-up was 6.5years. NF2 mutation was identified in 81% of the probands. The average growth rate based on the maximum linear diameter (DGR) was 1.68mm/year (n=33, average follow-up 4.22years) and 545mm3/year in volumetric assessment (VGR) for VS larger than 1cm (n=21, average follow-up 3.4years). In unoperated ears, hearing was stable in about 50% of ears. The mean change in dB HL was 9.5dB/year for pure-tone average and 3.5 for speech-recognition threshold (n=34, 5.5years 1-12). Eight children required removal through a translabyrinthine approach (mean follow-up was 4.5years), six patients were operated on for hearing preservation (mean postoperative follow-up 4.3years). Six patients were eligible for hearing rehabilitation with cochlear implantation (I), and five received placement of an auditory brainstem implant. Early diagnosis and treatment of small growing VS should be carefully discussed considering familial history and possible rehabilitation with a CI.