Follow-up for Brainstem Gliomas in Children

Frequency of Office Visits

Beyond the standard postoperative visits, follow-up is dictated by the tumor pathology (benign versus malignant), extent of resection, and postoperative neurological status.

• Patients with benign tumors: These patients can initially be seen 3 months after surgery when a new MRI scan is done. This scan will serve as the patient’s post-resection baseline scan. Patients are then seen annually thereafter if gross total or nearly gross total resection was obtained and there are minimal neurological sequelae and no hydrocephalus.
• Patients with malignant tumors: These patients should be followed more closely in a multidisciplinary fashion with early involvement by neuro-oncology. These patients will likely be seen weekly or bi-weekly by an oncologist, and surgical follow-up can be coordinated with them as necessary.

Frequency of Imaging

• Postoperative MRI: An MRI with and without contrast is obtained in the immediate postoperative period to document the extent of resection and to determine if there is any need to re-explore and attempt additional resection in the perioperative period.
• Baseline MRI: A follow-up MRI with and without contrast should be obtained around 3 months after surgery once the postoperative changes and edema have equilibrated, thereby allowing for a better assessment of residual tumor burden, if any.

Other Investigations Required

• Additional radiographic imaging: Images of the neuraxis may be required depending on the pathology encountered at the initial surgical intervention (e.g., total brain and spine MRI in the case of ependymoma).
• Laboratory studies: Various tests may be needed by the oncologists should the patient receive chemotherapy or radiation therapy to monitor for myelosuppression or associated toxicity.