SURGICAL TACTICS AND RESULTS OF TREATMENT OF HEAD NEUROFIBROMAS: A CLINICAL EXPERIENCE
DOI:
https://doi.org/10.11603/1811-2471.2025.v.i3.15555Keywords:
type 1 neurofibromatosis, plexiform tumor, microsurgery, mitogen-activated protein kinase inhibitors, 3D planning, reconstructive procedures, intraoperative monitoring, quality of lifeAbstract
SUMMARY. The aim – to improve the effectiveness of surgical treatment of patients with head neurofibromas by systematizing clinical experience in treating such patients in the context of type 1 neurofibromatosis (NF1), with an emphasis on the choice of surgical tactics, reconstruction methods, and the use of innovative technologies, especially regarding the combination of surgical and medical approaches to improve functional and aesthetic results.
Material and Methods. Current achievements and a clinical case of a patient with a head neurofibroma who underwent treatment at the Valikhnovski Surgery Institute were shown. Clinical examination, imaging methods (magnetic resonance imaging, Dopplerography), morphological confirmation, intraoperative neurophysiological monitoring, surgical methods (resection, microsurgery, laser ablation), reconstructive techniques (tissue expansion, free flaps), quality of life assessment, and statistical analysis of results at a p<0.05 level were presented.
Results. Surgical intervention led to sustained improvement. The main complications included neurological deficits, recurrences, and reconstruction complications (expander extrusion, flap necrosis). The integration of 3D visualization, mitogen-activated protein kinase inhibitors (selumetinib), and personalized planning significantly improves treatment effectiveness. The presented clinical case demonstrates the successful application of a comprehensive approach with radical tumor removal, reconstruction of the defect with local tissues, and long-term remission without recurrence.
Conclusions. Surgical treatment of head neurofibromas in patients with type 1 neurofibromatosis is an effective method that requires an individualized approach, taking into account the anatomical location and morphology of the tumor. Reconstructive interventions using tissue expansion and free flaps allow achieving high functional and aesthetic results even with large defects. The integration of intraoperative neuromonitoring, 3D visualization, and targeted therapy increases the safety of surgical interventions and expands the indications for the treatment of complex forms of neurofibromas. Prospects for further research include conducting multicenter prospective studies to standardize surgical tactics and reconstructive algorithms in patients with craniofacial neurofibromas, as well as studying the long-term effectiveness of combined treatment.
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