The article by Ramaswamy et al. represents an important milestone in the care of patients with neurofibromatosis type 1 (NF1) and plexiform neurofibromas (PN) by presenting the first Canadian national consensus on referral and management using a modified Delphi methodology.Reference Ramaswamy, Perreault, Lafay-Cousin, Singh and Larner¹ The strength of this work lies not only in its rigorous consensus-building approach but also in its ability to harmonize perspectives across diverse specialties in pediatric neuro-oncology, genetics, neurology, and beyond.

NF1-PN remains a uniquely challenging condition, characterized by early onset, complex tumor biology, risk of malignant transformation and variable clinical trajectories. The advent of MEK inhibitors has transformed the therapeutic landscape, but their integration into clinical practice has been heterogeneous and often inconsistent^{Reference Gross, Dombi and Widemann2,Reference de Blank, Gross and Akshintala3} . By achieving consensus on 41 of 43 statements across domains of diagnosis, treatment, monitoring and transition to adult care, the authors provide a pragmatic framework that will undoubtedly elevate standards of practice and patient outcomes nationally, while serving as a reference point internationally.

Several aspects are particularly commendable. First, the emphasis on early specialist referral reflects a growing recognition that timely intervention can alter trajectories of morbidity in NF1-PN.Reference Fisher, Blakeley and Weiss⁴ Second, the strong support for multidisciplinary care aligns with international recommendations and underscores the need to build networks that bridge pediatric and adult services.Reference Kerashvili and Gutmann⁵ Third, the proposed treatment algorithm balances evidence from clinical trials with real-world feasibility, including recognition of resource limitations such as volumetric Magnetic Resonance Imaging (MRI) availability.Reference Legius, Messiaen and Wolkenstein⁶

The consensus also highlights critical unmet needs, notably in ensuring continuity of care during transition to adulthood – a period often marked by fragmentation of services. By explicitly addressing this gap, the authors set the stage for broader system-level reforms.

In sum, this work provides a timely, methodologically sound and clinically relevant framework that will resonate with practitioners far beyond Canada. It represents a major step forward in unifying care for NF1-PN patients and will likely serve as a model for future international guideline development.