Follow-up for Cervical Encephaloceles in Children

Frequency of Office Visits

• Time of initial postoperative visit: The patient should be seen in the pediatric neurosurgery clinic 3–4 weeks after discharge or sooner if problems arise such as wound erythema or breakdown, CSF leak, fever, seizures, vomiting, lethargy, or irritability.
• Time of first follow-up visit and who should be seen: After the initial postoperative follow-up visit and as long as the patient is doing well without any problems, the patient should be seen approximately 1 month later in a multidisciplinary neural tube defects clinic by the developmental pediatrician and other physicians based on physical need such as a pediatric urologist, orthopedic surgeon, and/or neurosurgeon.
• Follow-up risk of developmental delay, hydrocephalus, and seizures: Close follow-up is indicated postoperatively to evaluate neurological function.  Patients should be evaluated to determine their need for physical, occupational, speech, and developmental therapies.  Patients are at risk for developing seizures and hydrocephalus postoperatively.  Seizures should be treated with the appropriate anticonvulsants, and hydrocephalus should be treated with ventriculoperitoneal shunt placement for CSF diversion to prevent leakage of CSF from the encephalocele repair site and associated infection. Patients with shunts placed for hydrocephalus should be followed every 3 months during the first year of life, every 6 months during the second year of life, and every year thereafter to ensure adequate shunt function. 

Frequency of Imaging

• Routine scanning if patient has shunt: Imaging studies should be obtained as needed to evaluate hydrocephalus and shunt function.

Other Investigations Required

• Postoperative MRI: A brain MRI, MRA, and MRV and a full spine MRI should be obtained postoperatively to evaluate the morphology of the remaining brain and spinal cord tissue, including the vasculature, and to provide a baseline for future comparison.