Table 5.

Guideline Recommendations for non-optic pathway glioma (non-OPG: low- or high-grade brain or spine glioma) in adults.

Non-optic pathway glioma in adults
No	Recommendations	Strength
1	Patients with NF1, their carers and primary care physicians should be educated about possible symptoms and signs of brain tumours in a manner appropriate to the individual patient.	moderate
2	Clinical assessment should take the form of examination for signs of brain tumours (amongst others new onset or change in seizures, new onset, unusual or concerning headache, endocrine problems related to hypothalamic dysfunction, focal neurological deficits, neuropsychological deficits) at every clinical visit.	moderate
3	Imaging screening for gliomas should be considered at the age of transition from childhood to adulthood for all patients with NF1 and should take the form of brain MRI with contrast. Imaging investigation should also be undertaken after new associated symptoms (amongst others new onset or change in seizures, new onset, unusual or concerning headache, endocrine problems related to hypothalamic dysfunction, focal neurological deficits, neuropsychological deficits) or positive physical examination findings.	moderate
4	Incidental detected gliomas should be followed up with imaging like sporadic incidental detected gliomas, with a first interval of 3 months, and if stable asymptomatic disease, intervals can be prolonged.	weak
5	Non-OPG in adults with NF1 should be managed and treated through the same care pathways as sporadic non-OPG. A multidisciplinary team should guide on appropriate therapeutic agents in the setting of NF1. Radiotherapy should be avoided if at all possible, and is not indicated in low-grade glioma, whilst recognising that it may be required as an important treatment option in the setting of high-grade glioma.	strong

Note. NF1 = Neurofibromatosis type 1; MRI = magnetic resonance imaging; OPG = optic pathway glioma.