Follow-up for Hydrocephalus due to Posterior Fossa Tumors in Children

Frequency of Office Visits

• Time of initial postoperative visit: Timing of the first office visit is standard for wound check and suture removal.
• First follow-up visit should precede initiation of adjuvant treatments for tumor: After tumor excision and hydrocephalus treatment, patients with malignant posterior fossa tumors typically require further oncological treatment with combinations of chemotherapy and radiotherapy. This treatment should start as soon as possible, certainly within the first 30 days of surgery. A clinical review shortly before commencement of oncological treatment is necessary to make sure that any possible shunt malfunction is detected and dealt with before chemotherapy starts.
• Subsequent visits: Clinical reviews are synchronized with oncological reviews to avoid multiple visits to the hospital. For patients who develop a shunt malfunction and require surgery while they are undergoing chemotherapy, particular attention should be paid to their platelet count and their coagulation status, as not uncommonly they are deranged and will need correction prior to surgery.

Frequency of Imaging

• Time of baseline scan: A baseline scan can be obtained as part of the assessment of the tumor being treated. Typically a scan is done during the initial hospitalization to assess the extent of tumor resection. The next scan is done approximately 3 months after the surgery.
• Frequency of subsequent scans: Patients with posterior fossa tumors are followed radiologically at regular intervals to monitor the response of the tumor to treatment. There is no need to obtain additional imaging studies for the hydrocephalus unless there is clinical suspicion of possible intracranial hypertension, which would indicate that there is shunt malfunction or inadequate function of the ventriculostomy. Typically, according to most oncological protocols, patients with malignant tumors are studied with MRI every 3 months in the first 2 years, every 6 months for the next 2 years, and yearly thereafter, or in variations thereof.