Follow-up After Surgery for Supratentorial Dysembryoplastic Neuroepithelial Tumors in Children

Frequency of Office Visits

• Initial perioperative visit: After surgery for DNET, the child usually will be seen for a wound check 8–10 days postoperatively, and a first visit to the neurosurgeon can be useful within the first several months.

• Subsequent visits: The later follow up should preferentially be done in a multidisciplinary setting, to allow the neurosurgeon, the epileptologist, and the oncologist to check the child and view the MRI.

• Oncological: MRI must be performed at certain intervals to detect residual tumor or recurrence.

• Epileptic: Seizure control must be ascertained by a neurologist, and antiepileptic drugs should be gradually withdrawn following the guidelines for other cases of resective epilepsy surgery.

Frequency of Imaging

• Early baseline scan: In general it is advisable to obtain MRI within several months of surgery.

• Subsequent follow-up scan frequency dependent on extent of resection: In cases of complete resection, after a baseline MRI early after the surgery, MRI should be done every 6 months initially, and annually after 2 years, on the condition that the MRI does not show residual tumor. In cases of subtotal or partial resection, MRI is performed every 4 months in the first year, every 6 months from years 1 to 5, and annually after 5 years.

• Length of need for follow-up scans not known: It is very likely that follow up with MRI can be stopped after some time in cases with no residual tumor. However, no definite guidelines exist to decide exactly when follow up is no longer needed.

Other Investigations Required

• EEGs and anticonvulsant serum drug levels: As stated in the previous paragraphs, a child with DNET should preferentially be followed in a multidisciplinary clinic. In most cases it will be possible to stop antiepileptic drugs after 1–2 years, depending on clinical and EEG results of the surgery. Usually, the guidelines after temporal lobectomy or amygdalohippocampectomy are used by analogy.