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Pathogenesis and treatment of a giant occipital bone defect with meningoencephalocele in an NF1 child: case report and review of the literature

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Abstract

Autosomal dominantly inherited neurofibromatosis type I (NF1) is a systemic disorder caused by a mutation of a gene on chromosome 17q11.2 and characterized by multiple café-au-lait spots, lentiginous macules, Lisch nodules of the iris, and tumors of the nervous system. Bony manifestations such as scoliosis, dysplasia of the greater sphenoidal wing, tibial pseudoarthrosis, short stature, and macrocephaly have been reported in approximately 50% of patients. However, calvarial bone defects are rare. After screening 324 articles, 23 cases (12 adult and 11 pediatric patients) of occipital bone defects in NF1 patients were selected. All patients had a single/multiple bone defect over the lambdoid suture. Adjacent benign plexiform neurofibromas were observed in 14 patients (60.8%, 7 adults and 7 children); one adult patient was diagnosed with neurofibrosarcoma. Meningoencephalocele over the occipital defect was noted in 8 cases (34.78%, all adults). Cranioplasty was performed in only 17.39% of patients. Histologic examination was performed in 7 of the 15 patients with associated neurofibromas/neurofibrosarcomas. Biopsy of the bone margins surrounding the defect was performed in only one case. Pathologic examination of the herniated parieto-occipital or cerebellar tissue was not performed in any of the patients studied. We report the case of a 9-year-old girl with NF1 and a significant occipital bone defect and performed a systematic review of the relevant literature to highlight the challenges in treating this condition and to investigate the underlying mechanisms contributing to bone defects or dysplasia in NF1.

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Authors and Affiliations

  1. Neurosurgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy

    Alice Antico, Francesca Vitulli, Gianluca Piatelli & Alessandro Consales

  2. Department of Neuroscience Rita Levi Montalcini, Neurosurgery Unit, University of Turin, Turin, Italy

    Alice Antico

  3. Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, “Federico II” University of Naples, Naples, Italy

    Francesca Vitulli

  4. Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy

    Andrea Rossi

  5. Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy

    Andrea Rossi

  6. Pathology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy

    Gabriele Gaggero

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AA, FV and AR. Surgery was performed by GP and AC. Histopathological examination was conducted by GG. All authors read and approved the final manuscript.

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Correspondence to Francesca Vitulli.

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Alice Antico and Francesca Vitulli share joint first authorship.

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Antico, A., Vitulli, F., Rossi, A. et al. Pathogenesis and treatment of a giant occipital bone defect with meningoencephalocele in an NF1 child: case report and review of the literature. Childs Nerv Syst 40, 27–39 (2024). https://doi.org/10.1007/s00381-023-06232-4

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