Follow-up After Surgery for Supratentorial Meningiomas in Children

Frequency of Office Visits

• First visit 2 – 4 weeks postoperatively, then according to center protocol: In general, the first follow-up visit should be 2 – 4 weeks after surgery. Similar to other recommendations for meningioma, the size and location of the mass, and associated findings such as hydrocephalus, may change the postoperative risk factors and need for follow-up. This regimen can be tailored to the patient’s case by the treating surgeon.
• More frequent visits if residual tumor or atypical tumor is present: For incompletely resected lesions, follow-up must be more frequent. Adjuvant radiotherapy is given immediately in some cases, but is given in other cases only if there is growth of the residual. It is cautious to recommend follow-up visits every 3 months for the first year, but this schedule may not always be feasible or necessary.

Frequency of Imaging

For completely resected lesions, the risk of recurrence is low, and follow-up imaging can be infrequent.

• Immediately after resection: Generally, there should be an immediate postoperative scan within 48 hours.
• Baseline image 3 months after resection: A repeat scan in 3 months, after resolution of postoperative changes, is advisable as a baseline.
• Subsequent imaging a function of risk recurrence and ease of scanning: The routine beyond the baseline image depends on several factors, including access to imaging in the medical system, the age of the child and need for sedation, and other risk factors such as NF2 and prior radiation. At the authors’ institution imaging for tumors is generally repeated every 3 – 6 months for 2 years post-operatively, then annually thereafter until about 5 years postoperatively. Because meningiomas are rare lesions, no specific protocol can be recommended on the basis of examination of case series.