Pediatric Neurofibromatosis Type 2 (NF2)

NF2 is sometimes referred to as central neurofibromatosis or bilateral acoustic neuroma disease. NF2 is different for each person, but because it affects nerves next to the brain or spinal cord, the problems of NF2 can cause serious disabilities. Even so, many people with NF2 can lead relatively normal, rewarding lives and learn to overcome obstacles they may encounter.

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In some people, signs of the disorder are detectable in childhood, but for the majority of people, NF2 is not apparent until late teenage years or later. Symptoms may be easily overlooked; people with NF2 may only have a few café-au-lait spots or skin tumors.

Everyone with NF2 has benign tumors affecting hearing and balance (vestibular schwannoma or acoustic neuroma). Cataracts in the lens or changes in the retina of the eye are present in most people. Tumors, which push on the brain or spinal cord (meningiomas and schwannomas), as well as tumors along the peripheral nerves (schwannomas), or tumors within the spinal cord occur in many people. These problems can be serious and cause weakness or seizures.

People with NF2 should realize that while the problems they face can be frightening, many important advances in treatment and detection of NF2 offer considerable hope.

What should you do if your child has NF-2?

People with NF-2 need regular physical examinations to check their hearing and neurologic function. Hearing tests of pure tones, auditory-evoked responses, balance tests, scans of the brain and spinal cord and eye exams will probably be needed annually. Because NF-2 will ultimately affect hearing in both ears, you will need to be open to several methods of communication. Sign language opens many opportunities outside of the home for the hearing impaired. It is most useful when the entire family learns to sign. Unfortunately, lip reading is often impractical for people with NF-2. Once the NF diagnosis has been made, it is important to begin a careful, organized program to spot any change in your body that could be caused by NF. Make regular visits to your doctor part of your routine.

People with NF-2 may need complicated surgery on more than one occasion. Surgery should be performed only by a neurosurgical or ear, nose and throat team with special expertise in NF-2. Specially-trained therapists, audiologists, ophthalmologists and counselors are also essential in the rehabilitation process. In some instances, surgery should be delayed because some tumors may show very little growth over many years and can be watched carefully. However, it is clear that the best results are obtained when problems are identified and treated early.

People with NF-2 need to be cautious of non-standard treatments. Treatment should always be discussed with physicians who have experience treating NF-2. While the problems in NF-2 can be very frightening, there is evidence of significant improvements in treatment methods which are very encouraging and indicate real hope for patients to lead extremely functional lives. There is also a community of people who can provide advice and support.

What are the guidelines for children with NF-2?

Evaluate other family members for vestibular tumors
Discuss inheritance of NF-2
Learn signing or alternative forms of communication
Have eye exam for cataracts and retinal abnormalities
Have MRI of brain and entire spinal cord annually
Have annual hearing tests
Have careful neurologic exam annually
Discuss potential impact of NF-2 on career and family
Assess resources and support needed for daily living

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