Follow-up After Treatment of Intramedullary Spinal Cord Tumors in Children

Frequency of Office Visits

30% of IMSCTs will progress within 5 years of surgery if an 80% resection is accomplished (10).  The progression rate will be higher with a smaller resection.   Therefore, scheduled follow-up is important.

• Benign, every year: Most IMSCTs in children are benign.  Consequently, a yearly visit is usually sufficient. The family should be educated about signs of tumor progression, however, so that timely scanning can be done if there is a suspicion of recurrence.
• Malignant, neuro-oncology follow-up: For the few who are diagnosed as having a malignant tumor, a more frequent follow-up schedule is indicated.  Frequently, adjuvant therapy is indicated, necessitating the participation of other specialties.  These services may see the patient weekly or more often, and surgical follow-up can be coordinated with them.

Frequency of Imaging

• Baseline MRI: A follow-up MRI with and without gadolinium around 3 months postoperatively gives an estimation of the postoperative state of the tumor. While the immediate postoperative scan is useful for identifying an inadequate resection, it is not an accurate scan to use to follow a patient for evidence of treatment failure. At that point there has been too little time for the establishment of an equilibrium between the residual tumor and surround normal parenchyma.  Additionally, there is too much postoperative artifact.  For these reasons it is wise to delay obtaining the initially “baseline” scan until approximately 3 months postoperatively.
• Subsequent MRI: Timing of the subsequent scans should be based on the tumor’s histology and biology, the amount of tumor left, and the patient’s condition. Typically, scans will be done every 6 months for several years and then yearly unless the tumor’s biology is aggressive.