Follow-up After Surgery for Supratentorial High-Grade Gliomas in Children

Frequency of Office Visits

• First postoperative office visit: After an uncomplicated clinical course, children should be seen within 1 month of surgery  Typically, a neurological examination and inspection of the incision (earlier if sutures/staples need to be removed) will be performed.   Repeat imaging may be ordered if indicated.  
• Subsequent routine follow-up: Children with HGGs require ongoing treatment and follow-up.  This is usually provided by the neuro-oncologist or neuro-oncology multidisciplinary team.

Frequency of Imaging

• Initial scan in perioperative period: The initial postoperative MRI is performed shortly after surgery. If there is a concern about hydrocephalus and the need for subsequent ETV or CSF diversion, serial CT scans may be required until the issue is resolved.
• Subsequent scan frequency commonly dictated by treatment protocol: Children will require multiple imaging studies depending on the treatment regimen and individual protocol. If the immediate postoperative MRI is deemed satisfactory with regard to determining extent of tumor resection, the next MRI is typically ordered by the oncologist either prior to beginning the chosen therapy or during therapy, as determined by protocol. If the immediate postoperative MRI is not conclusive because of unclear enhancement, stroke, blood, or other abnormalities, at least 2–4 weeks should pass before obtaining a baseline MRI. This is highly dependent on specific histology, planned treatment, and urgency in proceeding.

Other Investigations Required

• Anticonvulsant levels as required: For children on anticonvulsants, serum levels should be checked as per the neurologist’s practice.