Neurofibromatosis Type 2 (NF2)

What is neurofibromatosis type 2 (NF2)?

NF2-related schwannomatosis, formerly known as neurofibromatosis type 2 (NF2), is a genetic condition that affects your nervous system. A genetic change tells your body to overproduce cells that form tumors. These benign (noncancerous) tumors commonly grow in or on:

• Your peripheral nerves.
• The layer of tissue between your skull and brain (meninges).
• Your spine.
• Your hearing and balance nerves that connect your brain and inner ear.

NF2 is a type of neurofibromatosis, which is a group of conditions that affect your skin and nervous system.

How common is NF2-related schwannomatosis (neurofibromatosis type 2)?

NF2-related schwannomatosis (neurofibromatosis type 2) affects an estimated 1 in 33,000 births worldwide annually. It makes up about 3% of all diagnosed neurofibromatosis cases.

What are the symptoms of NF2-related schwannomatosis (neurofibromatosis type 2)?

Symptoms of NF2 vary based on where you have tumors and their size. The first symptoms you might notice happen as a result of tumors on your auditory nerves and include:

• Problems with balance (dizziness).
• Difficulty hearing.
• Ringing in your ears (tinnitus).

Symptoms caused by tumors outside of your auditory nerves include:

• Headaches.
• Numbness or muscle weakness.
• Facial paralysis.
• An elevated lesion on your skin (plaque) with skin discoloration or a small, round skin growth (nodule).
• Cloudy vision (cataracts).
• Pain (burning sensation) in your hands, arms, legs or feet.
• Seizures.

Most symptoms appear between late childhood and age 30. But the condition can affect anyone at any age. In adults, the tumors often affect the auditory nerves, causing hearing problems first. In children, tumors are often on their brain or spinal cord. If tumors show up during childhood or adolescence, that usually predicts a more severe disease course.

NF2 tumor types

Different types of tumors happen with NF2-related schwannomatosis (neurofibromatosis type 2):

• Schwannomas: A nervous system tumor made up of Schwann cells. These types of tumors grow along the auditory nerve that connects your brain and inner ear (called vestibular schwannomas). They also can grow on other cranial nerves like the ones responsible for eye movements, tongue movement and swallowing.
• Meningiomas: A type of brain tumor that forms in the tissue between your skull and brain (meninges).
• Gliomas: A type of brain tumor made up of glial cells. These tumors usually form around your optic (eye) nerves.
• Ependymomas: A type of glioma (brain and spinal cord tumor) that grows inside the ventricles and is made up of ependymal cells, which are the cells that produce the cerebrospinal fluid (CSF).

What causes NF2-related schwannomatosis (neurofibromatosis type 2)?

A genetic change of the neurofibromin 2 (NF 2) gene causes NF2. This is why the condition is known as NF2-related schwannomatosis. This gene helps in the production of merlin. It’s a protein that stops tumors from forming (tumor-suppressor).

When your body doesn’t have the proper instructions to create neurofibromin 2, some cells in your body won’t divide and replicate as they’re supposed to. Instead, your cells make too many copies of themselves. This causes tumors. Tumors are an abnormal cluster of cells that form a solid mass of tissue.

You can inherit the genetic change from one of your biological parents in an autosomal dominant pattern during conception. Many people don’t have a history of this genetic change in their biological family history, so they develop a new genetic change that occurs spontaneously during conception.

What are the risk factors for NF2-related schwannomatosis (neurofibromatosis type 2)?

You may be more at risk of developing neurofibromatosis type 2 if you have a history of the condition in your biological family.

What are the complications of NF2-related schwannomatosis (neurofibromatosis type 2)?

Complications of NF2 include:

• Hearing loss.
• Vision loss.
• Nerve damage.
• Fluid buildup in your brain.

Some NF2 tumors can develop into cancer.

How is NF2-related schwannomatosis (neurofibromatosis type 2) diagnosed?

A healthcare provider will diagnose NF2-related schwannomatosis (neurofibromatosis type 2) after a physical exam and testing. During the exam, they’ll look for signs of the condition, learn more about your family medical history and ask questions about your symptoms.

Imaging tests like an MRI can help them find tumors in your nervous system and skin. Other tests may include:

• A hearing test.
• An eye exam.
• Genetic testing.

How is NF2-related schwannomatosis (neurofibromatosis type 2) treated?

While there isn’t currently a cure for neurofibromatosis type 2, there have been multiple advances in diagnosing and treating NF2-related tumors. Your healthcare provider can direct you toward the best treatment available for your condition. Treatment could include:

• Surgery to remove tumors or treat cataracts.
• Chemotherapy or radiation therapy like stereotactic radiotherapy to reduce the size of tumors.
• Hearing aids, cochlear implants, an auditory brainstem implant for hearing preservation.
• Assistive devices for vision loss like glasses.
• Mobility devices for symptoms that affect your nerves and movement.
• Medications to manage symptoms like pain.

Your provider will offer treatment that’s ideal for you, as treatment can vary from person to person. In some cases, your healthcare provider may monitor how tumors affect you without treating them if they don’t cause symptoms that interfere with your daily routine. You’ll likely need at least one physical exam, imaging test, hearing test and vision test per year to keep track of how symptoms affect you.

Who treats NF2-related schwannomatosis (neurofibromatosis type 2)?

It’s very important that your NF2 care is treated by a multidisciplinary team with experience caring for individuals with NF2. The treatment team includes:

• Neuro-oncologists.
• Neurosurgeons.
• ENT surgeons.
• Audiologists.
• Genetic counselors.

Are there side effects of the treatment?

Side effects vary based on the type of treatment. The benefits of treatment must outweigh the risks for each option.

There’s a high risk associated with tumor removal surgery, especially as the location of the tumors may be near your brain, spinal cord or sitting on nerves near vital organs. Side effects may include bleeding, infection and nerve damage. Your surgeons and care team are highly trained to assess possible risks and prevent complications.

Side effects of chemotherapy and radiation therapy may include:

• Constipation.
• Diarrhea.
• Fatigue.
• Hair loss.
• Loss of appetite.
• Nausea and vomiting.

Talk to your provider about what side effects to look out for before you begin treatment.

What is the life expectancy of a person with NF2?

NF2-related tumors can affect your life expectancy, depending on their size, location and age at initial diagnosis. Sometimes, the tumors don’t cause symptoms, while others may cause severe symptoms. Your outlook improves if you receive an early diagnosis and treatment before complications happen. Your healthcare provider will examine how your symptoms affect you to give you a more accurate prognosis.

Your provider may recommend physical exams, imaging tests, and hearing and vision tests at least once a year to monitor tumor growth and treatment throughout your life, if necessary.

Can NF2-related schwannomatosis (neurofibromatosis type 2) be prevented?

You can’t prevent NF2-related schwannomatosis (neurofibromatosis type 2). If you’re looking to expand your family and want to learn more about your risk of having a child with a genetic condition, talk to a healthcare provider about genetic counseling.

When should I see a healthcare provider?

Visit a healthcare provider if you notice symptoms of NF2 like:

• Vision changes.
• Hearing changes.
• Muscle weakness or paralysis.
• Skin growths or changes to your skin.
• Headaches that don’t go away.
• Pain with an unknown cause.
• Seizures.

Changes to your vision and/or hearing are usually the first symptom(s) you’ll experience that will prompt you to see a healthcare provider.

What questions should I ask my healthcare provider?

• What is my outlook?
• Could my future children inherit this condition?
• What type of treatment do you recommend?
• Are there side effects?
• Can tumors return after removal?
• How often should I schedule follow-up appointments?
• Are there any clinical trials available for me?