ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2026
Management of plexiform neurofibromas in neurofibromatosis type 1: An Italian Delphi consensus.
Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPlexiform neurofibromas (PNs) are among the most complex and challenging manifestations of neurofibromatosis type 1 (NF1). Recent advances in understanding their epidemiology, natural history, biology, and imaging features, together with the introduction of MEK inhibitors, have significantly reshaped clinical management. Despite availability of international recommendations for tumor surveillance in NF1, several aspects of PN management remain incompletely defined in clinical practice.
methodsA multidisciplinary panel of 17 Italian NF1 experts conducted a Real-Time Delphi consensus process including a literature review, thematic analysis, and development of consensus statements. Key domains encompassed diagnosis, imaging assessment, surveillance, surgical evaluation, multidisciplinary management, and treatment of PNs. Two rounds of voting were conducted through a dedicated online platform, ensuring anonymity, real-time feedback, and iterative refinement of the statements.
resultsConsensus was achieved on 49 final statements. Key recommendations emphasized the importance of early identification of PNs, assessment of internal tumor burden through whole-body MRI, standardized imaging acquisition and reporting, timely recognition and characterization of distinct nodular lesions, and implementation of risk-adapted surveillance strategies. The panel also underscored the importance of patient education regarding signs suggestive of malignant transformation, and recommended a structured multidisciplinary approach to clinical decision-making. Agreement was additionally reached on practical aspects including radiological follow-up, criteria for surgical referral, definitions of PN-related symptoms, inoperability, and integration of surgical and targeted treatment strategies.
conclusionsThis national consensus provides an evidence-informed and clinically oriented framework for management of NF1-associated PNs. Complementing existing international recommendations, it offers practical guidance in areas where evidence remains limited.
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