Enigma in management of plexiform neurofibromas of bilateral brachial and lumbosacral plexuses: Shall we let nature take its course?

Sir, Plexiform neurofibroma (PN), usually associated with neurofibromatosis type 1, is a benign peripheral nerve sheath tumor, which consists of multiple, twisted masses that involve and infiltrate multiple nerve fascicles or branches of major nerves. MRI of the brachial plexus revealed multiple, lobular, expansive tumors in the distribution of the brachial plexus bilaterally, extending to the anterior mediastinum as well as the adjacent parapharyngeal spaces on both sides, and invading the spinal canal [Figure 2] and [Figure 3]a. MRI images of the arms showed a well-defined tubular mass lesion along all the brachial plexus nerve roots (the median, ulnar and radial nerves) from the visualised axillary region upto the distal arm [Figure 3]b.{Figure 2}{Figure 3} The MRI of the lumbosacral plexus showed involvement of both the plexuses and suggested the extension over bilateral parasacral region and the paravertebral soft tissue. During the follow-up period, the patient reported an improvement in her paresthesia without worsening of neurological deficit. [...]the management decision was to continue conservative management.