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Novegno F, Iaquinandi A, Ruggiero F, Salvati M. Leukoencephalopathy with Cerebral Calcifications and Cysts: The Neurosurgical Perspective. Literature Review. World Neurosurg 2024; 190:99-112. [PMID: 38968992 DOI: 10.1016/j.wneu.2024.06.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUNDS Labrune syndrome is a rare white matter disease characterized by angiomatous leukoencephalopathy, diffuse intracranial calcifications and supratentorial and infratentorial parenchymal cysts. The clinical worsening is often related to cyst expansion, and surgery may be advocated for symptomatic management in about one third of cases. However, no consensus exists on the surgical timing, the most effective procedure, and the long-term results. METHODS Electronic databases PubMed/MEDLINE and Google Scholar were searched for studies published up to April 2022 using the search string (Labrune syndrome OR leukoencephalopathy with calcifications and cysts OR brain calcifications OR brain cysts) AND (therapy OR surgery). RESULTS We found 28 studies in the literature, and we added a new case from our institution, comprising 37 patients. All the patients in this series underwent surgical intervention. We reviewed all the pertinent literature to discuss clinical-radiological features and etiopathogenesis, specifically addressing the surgical options, clinical results, and prognosis. CONCLUSIONS Leukoencephalopathy with cerebral calcifications and cysts is a rare neurodegenerative disorder for which effective medical treatment is lacking. Surgery remains the only therapeutic option to control the disease to reduce the mass effect of growing cystic lesions. Almost half of the patients who underwent surgery required further approaches, with great concern for the associated disabilities. Several procedures have been described, with no evidence regarding which procedure is the most effective. Individual-based surgical planning must be advocated, tailoring the approach to limit side effects. Mini-invasive neuroendoscopic approaches may be considered to achieve satisfactory results.
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Affiliation(s)
- Federica Novegno
- Department of Neurosurgery, Tor Vergata University Medical School, Rome, Italy.
| | - Andrea Iaquinandi
- Department of Neurosurgery, Policlinico Tor Vergata, University of Rome Tor Vergata. Rome, Italy
| | - Francesca Ruggiero
- Department of Neurosurgery, Tor Vergata University Medical School, Rome, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico Tor Vergata, University of Rome Tor Vergata. Rome, Italy
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Li J, Li C, Zhang Q, Qiu C. Leukoencephalopathy with calcifications and cysts: A case report with literature review. Neurol Sci 2023:10.1007/s10072-023-06776-y. [PMID: 37004603 DOI: 10.1007/s10072-023-06776-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Abstract
Leukoencephalopathy with calcifications and cysts (LCC; OMIM #614561) is a rare disease and at present there are less than 100 cases reported worldwide. Mutations in the SNORD118 gene is now known to be the cause of LCC. We present a case who was heterozygous for the n.70G>A and n.6C>T sequence variants of the SNORD118 gene, variants which to date have not been described. Compared with the cases that we reviewed, our patient had the second longest time to diagnosis (age 56) from onset of symptoms 40 years prior. Moreover, his cousin's family has a high prevalence of epilepsy. This paper reviewed all published reports to date that had descriptive cases involving LCC as well as testing for the SNORD118 gene. Since 1996 only 85 patients have been described in 59 case reports. In this review, we summarize their clinical features, especially central nervous system symptoms, treatment, pathology, and gene testing results.
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Affiliation(s)
- Jingya Li
- Department of Neurology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, Zhejiang Province, P. R. China
| | - Chun Li
- Department of Neurology, Anji Traditional Chinese Medical Hospital, 299 Shengli West Road,, Anji Huzhou, Zhejiang Province, P. R. China
| | - Qing Zhang
- Department of Neurology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, Zhejiang Province, P. R. China
| | - Chao Qiu
- Department of Neurology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, Zhejiang Province, P. R. China.
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Paff M, Samuel N, Alsafwani N, Paul D, Diamandis P, Climans SA, Kucharczyk W, Ding MYR, Gao AF, Lozano AM. Leukoencephalopathy with brain calcifications and cysts (Labrune syndrome) case report: diagnosis and management of a rare neurological disease. BMC Neurol 2022; 22:10. [PMID: 34986804 PMCID: PMC8729138 DOI: 10.1186/s12883-021-02531-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/21/2021] [Indexed: 12/05/2022] Open
Abstract
Background Leukoencephalopathy with brain calcifications and cysts (LCC; also known as Labrune syndrome) is a rare genetic microangiopathy caused by biallelic mutations in SNORD118. The mechanisms by which loss-of-function mutations in SNORD118 lead to the phenotype of leukoencephalopathy, calcifications and intracranial cysts is unknown. Case presentation We present the histopathology of a 36-year-old woman with ataxia and neuroimaging findings of diffuse white matter abnormalities, cerebral calcifications, and parenchymal cysts, in whom the diagnosis of LCC was confirmed with genetic testing. Biopsy of frontal white matter revealed microangiopathy with small vessel occlusion and sclerosis associated with axonal loss within the white matter. Conclusions These findings support that the white matter changes seen in LCC arise as a consequence of ischemia rather than demyelination.
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Affiliation(s)
- Michelle Paff
- Department of Neurological Surgery, University of California Irvine, Irvine, CA, USA
| | - Nardin Samuel
- Division of Neurosurgery, Department of Surgery, University Health Network, Toronto, ON, USA.
| | - Noor Alsafwani
- Laboratory Medicine Program, University Health Network, Toronto, ON, USA.,Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
| | - Darcia Paul
- Division of Neurosurgery, Department of Surgery, University Health Network, Toronto, ON, USA
| | - Phedias Diamandis
- Laboratory Medicine Program, University Health Network, Toronto, ON, USA
| | - Seth A Climans
- Division of Neurology, Department of Medicine, University Health Network, Toronto, ON, USA
| | - Walter Kucharczyk
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, USA
| | - Mandy Yi Rong Ding
- Division of Neurology, Department of Medicine, University Health Network, Toronto, ON, USA
| | - Andrew F Gao
- Laboratory Medicine Program, University Health Network, Toronto, ON, USA
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network, Toronto, ON, USA
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Murphy S, Grima G, Mankad K, Aquilina K. Paediatric neurosurgical implications of a ribosomopathy: illustrative case and literature review. Childs Nerv Syst 2022; 38:643-648. [PMID: 34018027 PMCID: PMC8917029 DOI: 10.1007/s00381-021-05208-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/05/2021] [Indexed: 11/08/2022]
Abstract
Ribosomopathies are rare, recently defined entities. One of these, Labrune syndrome, is recognisable radiologically by its distinctive triad of leukoencephalopathy, intracranial calcifications and cysts (LCC). These cysts may have neurosurgical implications at different ages because of their progressive expansion and local mass effect. The aetiology of LCC is related to a widespread cerebral microangiopathy and is due to a genetic mutation in SNORD118, responsible for stabilisation of the large ribosomal subunit during assembly.
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Affiliation(s)
- Suzanne Murphy
- School of Medicine, Royal College of Surgeons, Dublin, Ireland.
| | - Gabriella Grima
- grid.420468.cDepartment of Neurosurgery, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Kshitij Mankad
- grid.420468.cDepartment of Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Kristian Aquilina
- grid.420468.cDepartment of Neurosurgery, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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Neuroimaging findings in leukoencephalopathy with calcifications and cysts: case report and review of the literature. Neurol Sci 2021; 42:4471-4487. [PMID: 34482485 DOI: 10.1007/s10072-021-05560-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
Leukoencephalopathy with cerebral calcifications and cysts (LCC) is a neurological disorder characterized by the radiological triad of white matter abnormalities, intracranial calcifications and cystic lesions variable in size resulting from a diffuse cerebral microangiopathy. Typically, progressive focal neurological deficits and seizures are the first clinical manifestation, but the severity of symptoms can vary according to the size and location of the cystic lesions holding compressive effects on the surrounding brain tissue. The most common histopathological finding is diffuse microangiopathy, which might be associated to pathogenic mutations in SNORD118 gene causing Labrune syndrome. Similar neuroradiological appearances have been found in the Coats plus syndrome, a systemic disorder caused by a genetic diffuse microangiopathy that affects not only the brain but also the retina and multiple organs, with a more complex clinical picture that address the diagnosis; biallelic mutations in CTC1 gene, encoding the conserved telomere maintenance component 1 (CTC1), are responsible of this systemic disorder. The aim of this contribution is to review the existing literature focusing on the neuroimaging characteristics by reporting cases in which radiological findings were highly suggestive for LCC.
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Kobets A, Oriko D, Groves M, Robinson S, Cohen A. Surgical considerations in Labrune syndrome. Childs Nerv Syst 2021; 37:1765-1770. [PMID: 32789548 DOI: 10.1007/s00381-020-04861-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/06/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Labrune syndrome (LS) is a rare white matter disease characterized by leukoencephalopathy with intracranial calcification and cysts (LCC). While the intracranial cyst characteristics of LS are for the most part stable, some may require surgical intervention when they develop associated hemorrhage and/or mass effect. To date, no review of the surgical outcomes of cyst decompression in LS has been performed. CASE PRESENTATION We report the case of a 16-year-old girl with LS who presented with progressive right hemiparesis from an enlarging hemorrhagic left thalamic cyst. The patient underwent frameless stereotactic cyst aspiration and Ommaya reservoir placement and her hemiparesis subsequently improved. Serial monitoring demonstrated stable decompression of the cyst. CONCLUSIONS The pathophysiology of LS is thought to be diffuse cerebral microangiopathy and it is thought that these microhemorrhages contribute to the formation of intracranial cysts as well as diffuse calcifications. Indications for surgical intervention in LS are not well established and the heterogeneity of lesions compels them to be managed on a case-by-case basis. Based on our literature review, surgery is the standard treatment of choice for patients with progressive symptoms and growing lesions on imaging studies, with outcomes favoring less-invasive stereotactic approaches with contingencies of reservoir placement when cysts recur.
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Affiliation(s)
- Andrew Kobets
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - David Oriko
- University of Nairobi School of Medicine, Nairobi, Kenya
| | - Mari Groves
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shenandoah Robinson
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Alan Cohen
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Bonomo G, Monfrini E, Borellini L, Bonomo R, Arienti F, Saetti MC, Di Fonzo A, Locatelli M. Systemic involvement in adult-onset leukoencephalopathy with intracranial calcifications and cysts (Labrune syndrome) with a novel mutation of the SNORD118 gene. Eur J Neurol 2020; 27:2329-2332. [PMID: 32400930 DOI: 10.1111/ene.14313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Although Labrune syndrome is a well-known disorder characterized by a typical neuroradiological triad, namely leukoencephalopathy, intracranial calcifications and cysts, there are no reports of systemic involvement in this disorder. This paper attempts to describe a peculiar clinical manifestation related to a novel mutation in the SNORD118 gene. METHODS Clinical examination, brain and total-body imaging, and neurophysiological and ophthalmological investigations were performed. Amplification of the SNORD118 gene and Sanger sequencing were integrated to investigate potential causative mutations. RESULTS A 69-year-old woman, with a long history of episodes of vertigo and gait imbalance, was referred to our hospital for progressive cognitive and motor deterioration. Computed tomography and magnetic resonance imaging disclosed diffuse bilateral leukoencephalopathy in periventricular and deep white matter, widespread calcifications and numerous cysts in the brain, liver, pancreas and kidneys. The genetic analysis revealed two biallelic variants in the SNORD118 gene, one of which is novel (n.60G>C). CONCLUSIONS This is the first report of adult-onset Labrune syndrome with an unusual systemic involvement presenting a novel mutation in the SNORD118 gene.
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Affiliation(s)
- G Bonomo
- Neurosurgery Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - E Monfrini
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
| | - L Borellini
- Department of Neuropathophysiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - R Bonomo
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - F Arienti
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
| | - M C Saetti
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
| | - A Di Fonzo
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
| | - M Locatelli
- Neurosurgery Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy.,Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Milan, Italy
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Chiba K, Aihara Y, Kawamata T. Intrinsic Well-Demarcated Midline Brainstem Lesion Successfully Resected through a Midline Pontine Splitting Approach. Pediatr Neurosurg 2020; 55:444-450. [PMID: 33333533 DOI: 10.1159/000511878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/29/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Surgical approaches to intrinsic pontine lesions are technically difficult and prone to complications. The surgical approach to the brainstem through midline pontine splitting is regarded as safe since there are no crossing vital fibers in the midline between the abducens nuclei at the facial colliculi in the pons and the oculomotor nucleus in the midbrain, although its actual utilization has not been reported previously. CASE PRESENTATION A 6-year-old boy presented with a large intrinsic cystic lesion in the pons. We successfully achieved gross total removal via the median sulcus of the fourth ventricle. The fixation in adduction and limitation of abduction were newly observed in the left eye after surgery. DISCUSSION The advantage of the surgical approach through the median sulcus is the longer line of dissection in an axial direction and the gain of a wider operative view. On the other hand, the disadvantage of this approach is the limited orientation and view toward lateral side and a possible impairment of the medial longitudinal fasciculi and paramedian pontine reticular formation, which are located lateral to the midline sulcus bilaterally and are easily affected via the median sulcus of the fourth ventricular floor. Ongoing developments in intraoperative neuro-monitoring and navigation systems are expected to enhance this promising approach, resulting in a safer and less complicated procedure in the future. CONCLUSION The surgical approach through midline pontine splitting is suitable for midline and deep locations of relatively large pontine lesions that necessitate a wider surgical window.
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Affiliation(s)
- Kentaro Chiba
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasuo Aihara
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan,
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
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